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NPI Code Detail

MEDICARE: DOUGLAS ACCOUNTIUS RN, MBA, AG-ACNP-BC

MEDICARE: DOUGLAS ACCOUNTIUS RN, MBA, AG-ACNP-BC
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
1363LA2100XAcute Care Nurse PractitionerCNP-03124NM

General Provider Information

NPI Number : 1730625047
Entity Type Code : Individual
Provider Name (Legal Business Name) : DOUGLAS ACCOUNTIUS RN, MBA, AG-ACNP-BC
Provider Business Mailing Address
First Line : PO BOX 5685
Second Line :
City : FARMINGTON
State : NM
Zip : 87499-5685
Country : US
Telephone Number : 505-635-6547
Fax Number : 505-365-6547
Provider Business Practice Location Address
First Line : NORTHERN NAVAJO MEDICAL CENTER
Second Line : HIGHWAY 491 NORTH
City : SHIPROCK
State : NM
Zip : 87420-5685
Country : US
Telephone Number : 505-368-6462
Fax Number : 505-365-6547
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/10/2017
Last Update Date : 01/10/2017

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