Provider Demographics
NPI:1295186518
Name:SHIKOBA HEALING, LLC
Entity Type:Organization
Organization Name:SHIKOBA HEALING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MS
Authorized Official - First Name:PHYLLIS
Authorized Official - Middle Name:E
Authorized Official - Last Name:CLICK
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:520-349-7275
Mailing Address - Street 1:9194 S WOOD CREEK LN
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85756-6128
Mailing Address - Country:US
Mailing Address - Phone:520-349-7275
Mailing Address - Fax:520-749-0053
Practice Address - Street 1:9194 S WOOD CREEK LN
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85756-6128
Practice Address - Country:US
Practice Address - Phone:520-349-7275
Practice Address - Fax:520-749-0053
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-28
Last Update Date:2016-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZP24781Medicare UPIN