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General NPI Number Information
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NPI Number | 1770762403
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Entity Type | Organization
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Legal Business Name | CARL T HAYDEN VA HOSPITAL
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Dates
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Enumeration Date | 10/30/2007
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Last Update Date | 10/30/2007
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Provider Practice Location Address
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Address Line | 22851 S 204TH ST
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City | QUEEN CREEK
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State | AZ
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Zip | 85242-6275
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Country | US
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Telephone | 480-656-9503
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Fax |
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Provider Business Mailing Address
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Address Line | 22851 S 204TH ST
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City | QUEEN CREEK
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State | AZ
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Zip | 85242-6275
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Country | US
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Telephone | 480-656-9503
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Fax |
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Authorized Official
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Title or Position | RN
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Name | MISS SHIRLEY GEPIGA RUE
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Credential |
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Telephone | 480-656-9503
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282N00000X
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Taxonomy Name | General Acute Care Hospital
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License Number | RN139479
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License Number State | AZ
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