=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568697282
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ABUNDANT HEALTH FAMILY PRACTICE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/26/2009
-----------------------------------------------------
Last Update Date | 08/23/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2055 W HOSPITAL DR SUITE 295
-----------------------------------------------------
City | TUCSON
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85704-7892
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 520-326-1457
-----------------------------------------------------
Fax | 520-326-1464
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2055 W HOSPITAL DR SUITE 295
-----------------------------------------------------
City | TUCSON
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85704-7892
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 520-326-1457
-----------------------------------------------------
Fax | 520-326-1464
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CO OWNER
-----------------------------------------------------
Name | RACHEL E GORDON
-----------------------------------------------------
Credential | FNPC
-----------------------------------------------------
Telephone | 520-326-1457
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------