Provider Demographics
NPI:1184013310
Name:MARICOPA UNIFIED SCHOOL DISTRICT
Entity Type:Organization
Organization Name:MARICOPA UNIFIED SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR HEALTH SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:MARILYN
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:WYANT
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:520-568-5100
Mailing Address - Street 1:44150 W MARICOPA CASA GRANDE HWY
Mailing Address - Street 2:
Mailing Address - City:MARICOPA
Mailing Address - State:AZ
Mailing Address - Zip Code:85138-5900
Mailing Address - Country:US
Mailing Address - Phone:520-568-5100
Mailing Address - Fax:520-568-5110
Practice Address - Street 1:44150 W MARICOPA CASA GRANDE HWY
Practice Address - Street 2:
Practice Address - City:MARICOPA
Practice Address - State:AZ
Practice Address - Zip Code:85138-5900
Practice Address - Country:US
Practice Address - Phone:520-568-5100
Practice Address - Fax:520-568-5110
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MARICOPA UNIFIED SCHOOL DISTRICT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-01-12
Last Update Date:2015-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLP049189251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care