1376544882 NPI number — KAREN SUE WOOLF ANP-C

Table of content: KAREN SUE WOOLF ANP-C (NPI 1376544882)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376544882 NPI number — KAREN SUE WOOLF ANP-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WOOLF
Provider First Name:
KAREN
Provider Middle Name:
SUE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
ANP-C
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:
1376544882
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3130 N 85TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SCOTTSDALE
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85251-5907
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
602-702-4318
Provider Business Mailing Address Fax Number:
480-945-0183

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3130 N 85TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SCOTTSDALE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85251-5907
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-702-4318
Provider Business Practice Location Address Fax Number:
480-945-0183
Provider Enumeration Date:
08/09/2005

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: 363LA2200X , with the licence number:  RN039031 , 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: 426389 . This is a "AHCCS" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: APIPA . This is a "APIPA" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: PNP13WOOLKA1 . This is a "MERCY CARE" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".