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General NPI Number Information
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NPI Number | 1871115832
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Entity Type | Individual
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Provider Name | SHEILA BLACK FNP-C
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Gender | Female
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Dates
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Enumeration Date | 05/13/2020
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Last Update Date | 02/03/2025
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Provider Practice Location Address
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Address Line | 1001 DIVISION ST
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City | PRESCOTT
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State | AZ
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Zip | 86301-1601
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Country | US
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Telephone | 928-445-5648
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Fax | 928-445-5079
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Provider Business Mailing Address
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Address Line | PO BOX 10880
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City | PRESCOTT
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State | AZ
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Zip | 86304-0880
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Country | US
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Telephone | 602-406-4786
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Fax | 916-636-4358
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 240338
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License Number State | AZ
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