1871545905 NPI number — JEAN R TURNEY-SHAW FNP

Table of content: JEAN R TURNEY-SHAW FNP (NPI 1871545905)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871545905 NPI number — JEAN R TURNEY-SHAW FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TURNEY-SHAW
Provider First Name:
JEAN
Provider Middle Name:
R
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
FNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1871545905
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/20/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1508
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLAYPOOL
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85532-1508
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
928-402-0952
Provider Business Mailing Address Fax Number:
928-425-7566

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
108 S BROAD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GLOBE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85501-2602
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-425-6592
Provider Business Practice Location Address Fax Number:
928-425-7566
Provider Enumeration Date:
05/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  AP1479 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1205962792 . This is a "NPI MEDCOM MEDICAL, LLC" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: Z71760 . This is a "MEDCOM MEDICAL, LLC PTAN#" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: Z158196 . This is a "MEDICARE PTAN" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: Q08431 . This is a "MEDICARE" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 1871545905 . This is a "NPI JEAN TURNEY-SHAW" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 840985 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".




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