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NPI Code Detail

MEDICARE: MS. MARY LOUISE LOTTEN RN

MEDICARE: MS. MARY LOUISE LOTTEN RN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163WS0200XSchool Registered NurseRN095491AZ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1285771048
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. MARY LOUISE LOTTEN RN
Provider Business Mailing Address
First Line : 2401 E ELDER DR
Second Line :
City : FLAGSTAFF
State : AZ
Zip : 86004-1835
Country : US
Telephone Number : 928-526-8946
Fax Number :
Provider Business Practice Location Address
First Line : 3285 E SPARROW AVE
Second Line :
City : FLAGSTAFF
State : AZ
Zip : 86004-7794
Country : US
Telephone Number : 928-527-6118
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/31/2007
Last Update Date : 07/08/2007

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