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General NPI Number Information
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NPI Number | 1912030370
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Entity Type | Organization
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Legal Business Name | SAN CARLOS APACHE TRIBE
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Dates
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Enumeration Date | 03/14/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1 MOHAVE AVENUE
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City | SAN CARLOS
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State | AZ
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Zip | 85550
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Country | US
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Telephone | 928-475-2798
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Fax | 928-475-5925
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Provider Business Mailing Address
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Address Line | PO BOX 0
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City | SAN CARLOS
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State | AZ
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Zip | 85550
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Country | US
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Telephone | 928-475-2798
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Fax | 928-475-5925
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Authorized Official
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Title or Position | TRIBAL CHAIRMAN
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Name | MR. WENDSLER NOSIE
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Credential |
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Telephone | 928-475-2361
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 85002233
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License Number State | AZ
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