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General NPI Number Information
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NPI Number | 1801075122
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Entity Type | Organization
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Legal Business Name | PATAKENS LTD
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Dates
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Enumeration Date | 11/02/2007
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Last Update Date | 11/02/2007
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Provider Practice Location Address
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Address Line | 1871 GATES AVE
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City | KINGMAN
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State | AZ
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Zip | 86401-4017
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Country | US
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Telephone | 928-753-3332
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Fax | 928-753-2662
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Provider Business Mailing Address
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Address Line | PO BOX 6215
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City | KINGMAN
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State | AZ
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Zip | 86402-6215
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Country | US
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Telephone | 928-753-3332
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Fax | 928-753-2662
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Authorized Official
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Title or Position | NURSE PRACTIONER/OWNER
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Name | CHERYL L WEBB
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Credential | RN,MS,C-FNP
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Telephone | 928-753-3332
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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 | RN049098
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License Number State | AZ
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