Provider Demographics
NPI:1164996435
Name:RANGER, CONNIE
Entity Type:Individual
Prefix:MRS
First Name:CONNIE
Middle Name:
Last Name:RANGER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O BOX 1340,
Mailing Address - Street 2:1.5 MILE WEST PINON RODEO GROUND
Mailing Address - City:PINON
Mailing Address - State:AZ
Mailing Address - Zip Code:86510
Mailing Address - Country:US
Mailing Address - Phone:928-241-0457
Mailing Address - Fax:
Practice Address - Street 1:1.5 MILE WEST PINON RODEO GROUND
Practice Address - Street 2:
Practice Address - City:PINON
Practice Address - State:AZ
Practice Address - Zip Code:86510
Practice Address - Country:US
Practice Address - Phone:928-241-0457
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-19
Last Update Date:2019-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0218-87663747A0650X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider