Provider Demographics
NPI:1275837932
Name:RODMAN, ANNIE MARIE (MSN/FNP)
Entity Type:Individual
Prefix:
First Name:ANNIE
Middle Name:MARIE
Last Name:RODMAN
Suffix:
Gender:F
Credentials:MSN/FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1510 E WAGON WHEEL LN
Mailing Address - Street 2:SUITE 106
Mailing Address - City:FORT MOHAVE
Mailing Address - State:AZ
Mailing Address - Zip Code:86426-6697
Mailing Address - Country:US
Mailing Address - Phone:928-788-9378
Mailing Address - Fax:928-788-9381
Practice Address - Street 1:1510 E WAGON WHEEL LN
Practice Address - Street 2:SUITE 106
Practice Address - City:FORT MOHAVE
Practice Address - State:AZ
Practice Address - Zip Code:86426-6697
Practice Address - Country:US
Practice Address - Phone:928-788-9378
Practice Address - Fax:928-788-9381
Is Sole Proprietor?:No
Enumeration Date:2011-01-10
Last Update Date:2011-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN094835 AP1618363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily