=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528491131
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARYLOU KARAMBIZI NP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/19/2013
-----------------------------------------------------
Last Update Date | 02/06/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 200 HOSPITAL DRIVE
-----------------------------------------------------
City | WHITERIVER
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85941-0860
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 928-338-4911
-----------------------------------------------------
Fax | 928-338-5508
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 860 200 HOSPITAL DRIVE
-----------------------------------------------------
City | WHITERIVER
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85941-0860
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 928-338-4911
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LA2200X
-----------------------------------------------------
Taxonomy Name | Adult Health Nurse Practitioner
-----------------------------------------------------
License Number | RN199760
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------