=====================================================
General NPI Number Information
=====================================================
NPI Number | 1417121765
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | IMOGENE A BELL, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/17/2008
-----------------------------------------------------
Last Update Date | 04/17/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 480 N MORLEY AVE
-----------------------------------------------------
City | NOGALES
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85621-2930
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 520-287-2726
-----------------------------------------------------
Fax | 520-287-6159
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 480 N MORLEY AVE
-----------------------------------------------------
City | NOGALES
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85621-2930
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 520-287-2726
-----------------------------------------------------
Fax | 520-287-6159
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MRS. IMOGENE ADAIR BELL
-----------------------------------------------------
Credential | FNP
-----------------------------------------------------
Telephone | 520-287-2726
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 364SF0001X
-----------------------------------------------------
Taxonomy Name | Family Health Clinical Nurse Specialist
-----------------------------------------------------
License Number | RN015488
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------