=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376820258
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THE NURSES OFFICE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/07/2011
-----------------------------------------------------
Last Update Date | 11/07/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1757 W JACKSON LN
-----------------------------------------------------
City | LAKESIDE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85929-7301
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 928-368-0461
-----------------------------------------------------
Fax | 928-368-4333
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1757 W JACKSON LN
-----------------------------------------------------
City | LAKESIDE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85929-7301
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 928-368-0461
-----------------------------------------------------
Fax | 928-368-4333
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | MS. DEBRA FRANCES STUART-SMALLEY
-----------------------------------------------------
Credential | CNM
-----------------------------------------------------
Telephone | 928-368-0461
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QH0100X
-----------------------------------------------------
Taxonomy Name | Health Service Clinic/Center
-----------------------------------------------------
License Number | OTC4051
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------