Provider Demographics
NPI:1194043463
Name:PALO VERDE
Entity Type:Organization
Organization Name:PALO VERDE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SCHOOL NURSE
Authorized Official - Prefix:MS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:DIANNE
Authorized Official - Last Name:KENNISON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:520-584-7417
Mailing Address - Street 1:1302 S AVENIDA VEGA
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85710-5101
Mailing Address - Country:US
Mailing Address - Phone:520-584-7417
Mailing Address - Fax:520-584-7401
Practice Address - Street 1:1302 E. AVENIDA VEGA
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85710
Practice Address - Country:US
Practice Address - Phone:520-584-7417
Practice Address - Fax:520-584-7401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-12
Last Update Date:2010-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN158546251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)