1982819264 NPI number — MRS. FERN MARIE RAY

Table of content: MRS. FERN MARIE RAY (NPI 1982819264)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982819264 NPI number — MRS. FERN MARIE RAY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RAY
Provider First Name:
FERN
Provider Middle Name:
MARIE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
NEZ-RAY
Provider Other First Name:
FERN
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1982819264
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P. O. BOX 3309
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
INDIAN WELLS
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
86031
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
928-521-2546
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
NAVAJO RESERVATION
Provider Second Line Business Practice Location Address:
10 MILES WEST OF WHITE CONE FROM ROAD 77
Provider Business Practice Location Address City Name:
INDIAN WELLS
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
86031
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-521-2546
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/11/2007

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: 372600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 372500000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 3747A0650X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 374U00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 376J00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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

  • Identifier: 777732 . This is a "STATE PROVIDE ID" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".