1891095667 NPI number — MARY J HUFF PSYCHIATRIC NURSE PRACTITIONER PLLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891095667 NPI number — MARY J HUFF PSYCHIATRIC NURSE PRACTITIONER PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARY J HUFF PSYCHIATRIC NURSE PRACTITIONER PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1891095667
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/27/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3658
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FLAGSTAFF
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
86003-3658
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
928-308-3715
Provider Business Mailing Address Fax Number:
928-778-3464

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
143 N MCCORMICK ST
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
PRESCOTT
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
86301-2723
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-308-3715
Provider Business Practice Location Address Fax Number:
928-778-3464
Provider Enumeration Date:
10/27/2010

Additional Information

Authorized Official

Authorized Official Last Name:
HUFF
Authorized Official First Name:
MARY
Authorized Official Middle Name:
JANE
Authorized Official Title or Position:
PSYCHIATRIC NURSE PRACTITIONER
Authorized Official Telephone Number:
928-308-3715

Provider Taxonomy Codes

  • Taxonomy code: 363LP0808X , with the licence number:  AP2067 , 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)





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