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General NPI Number Information
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NPI Number | 1710337621
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Entity Type | Organization
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Legal Business Name | PRIOLA PRIMARY PALLIATIVE AND HOSPICE CARE, PLLC
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Dates
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Enumeration Date | 06/21/2016
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 3105 CLEARWATER DR STE B
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City | PRESCOTT
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State | AZ
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Zip | 86305-7166
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Country | US
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Telephone | 928-778-0626
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Fax | 888-289-2598
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Provider Business Mailing Address
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Address Line | 3105 CLEARWATER DR STE B
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City | PRESCOTT
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State | AZ
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Zip | 86305-7166
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Country | US
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Telephone | 928-778-0626
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Fax | 888-289-2598
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Authorized Official
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Title or Position | OWNER
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Name | MARK PRIOLA
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Credential | FNP-C
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Telephone | 928-778-0626
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | AP3629
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License Number State | AZ
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