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General NPI Number Information
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NPI Number | 1538354188
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Entity Type | Organization
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Legal Business Name | COPPER BASIN FAMILY MEDICINE PLLC
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Dates
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Enumeration Date | 09/06/2007
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Last Update Date | 05/08/2008
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Provider Practice Location Address
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Address Line | 20185 E OCOTILLO RD SUITE 104
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City | QUEEN CREEK
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State | AZ
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Zip | 85242-7663
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Country | US
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Telephone | 480-888-2010
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Fax | 480-888-2074
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Provider Business Mailing Address
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Address Line | 20185 E OCOTILLO RD SUITE 104
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City | QUEEN CREEK
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State | AZ
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Zip | 85242-7663
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Country | US
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Telephone | 480-888-2010
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Fax | 480-888-2074
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. BARBARA MICHELLE HOOSE
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Credential | RN MSN FNP-C
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Telephone | 480-888-2010
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | AP2470
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License Number State | AZ
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