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General NPI Number Information
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NPI Number | 1528402039
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Entity Type | Organization
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Legal Business Name | NEUROPATHY AND PAIN CENTRE OF PRESCOTT LLC
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Dates
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Enumeration Date | 04/26/2013
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Last Update Date | 03/04/2014
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Provider Practice Location Address
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Address Line | 1000 WILLOW CREEK RD SUITE D
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City | PRESCOTT
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State | AZ
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Zip | 86301-1645
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Country | US
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Telephone | 928-458-7343
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Fax | 928-257-4422
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Provider Business Mailing Address
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Address Line | 1000 WILLOW CREEK RD SUITE D
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City | PRESCOTT
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State | AZ
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Zip | 86301-1645
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Country | US
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Telephone | 928-458-7343
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SUSAN MOORE
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Credential |
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Telephone | 928-458-7343
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | AP3075
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | AP3075
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License Number State | AZ
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