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General NPI Number Information
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NPI Number | 1487791083
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Entity Type | Organization
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Legal Business Name | DESERT FAMILY HEALTH CARE LLC
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Dates
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Enumeration Date | 01/31/2007
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 765 W AZURE DR
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City | CAMP VERDE
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State | AZ
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Zip | 86322-4945
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Country | US
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Telephone | 928-451-6559
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Fax |
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Provider Business Mailing Address
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Address Line | 765 W AZURE DR
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City | CAMP VERDE
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State | AZ
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Zip | 86322-4945
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Country | US
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Telephone | 928-451-6559
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | MRS. LAURA D HANSON
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Credential | M.S. F.N.P.
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Telephone | 928-451-6559
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number | RN 114868 AP 2200
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License Number State | AZ
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