MEDICARE: INGA BRIANNE SLADE

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
1	171W00000X	Contractor	12226141	AZ

General Provider Information

NPI Number	:	1326735614
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	INGA BRIANNE SLADE

Provider Business Mailing Address
First Line	:	PO BOX 86537
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85754-6537
Country	:	US
Telephone Number	:	520-721-1887
Fax Number	:	520-407-5338

Provider Business Practice Location Address
First Line	:	944 N DESERT AVE APT C
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85711-2039
Country	:	US
Telephone Number	:	801-403-3783
Fax Number	:	520-407-5338

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/18/2023
Last Update Date	:	04/18/2023

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Directions to “ INGA BRIANNE SLADE ” Practice Location

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