Provider Demographics
NPI:1093908527
Name:CAMP VERDE FAMILY HEALTH LLC
Entity Type:Organization
Organization Name:CAMP VERDE FAMILY HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DELYTE
Authorized Official - Middle Name:
Authorized Official - Last Name:NASCH
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:928-639-5555
Mailing Address - Street 1:PO BOX 3340
Mailing Address - Street 2:
Mailing Address - City:CAMP VERDE
Mailing Address - State:AZ
Mailing Address - Zip Code:86322-3340
Mailing Address - Country:US
Mailing Address - Phone:928-639-5555
Mailing Address - Fax:
Practice Address - Street 1:460 W FINNIE FLATS RD
Practice Address - Street 2:
Practice Address - City:CAMP VERDE
Practice Address - State:AZ
Practice Address - Zip Code:86322-7266
Practice Address - Country:US
Practice Address - Phone:928-639-5555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-17
Last Update Date:2007-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP2777363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty