Provider Demographics
NPI:1285635037
Name:NAMKA, NANCY LYNNE (ED D)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:LYNNE
Last Name:NAMKA
Suffix:
Gender:F
Credentials:ED D
Other - Prefix:DR
Other - First Name:LYNNE
Other - Middle Name:
Other - Last Name:NAMKA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ED D
Mailing Address - Street 1:5398 E GOLDER RANCH DR
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85739-4270
Mailing Address - Country:US
Mailing Address - Phone:520-825-4766
Mailing Address - Fax:520-825-0556
Practice Address - Street 1:7493 N ORACLE RD
Practice Address - Street 2:SUITE 123
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-6343
Practice Address - Country:US
Practice Address - Phone:520-825-4766
Practice Address - Fax:520-825-0556
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1236103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZPR5510388002OtherCIGNA
AZAZ0136870OtherBLUE CROSS BLUE SHIELD
AZPR5510388002OtherCIGNA