Provider Demographics
NPI:1437613494
Name:JUSTOVA, VERA (RN BSN)
Entity Type:Individual
Prefix:
First Name:VERA
Middle Name:
Last Name:JUSTOVA
Suffix:
Gender:F
Credentials:RN BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1550 E THUNDERBIRD RD APT 2107
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85022-5617
Mailing Address - Country:US
Mailing Address - Phone:480-254-9831
Mailing Address - Fax:520-383-7255
Practice Address - Street 1:HIGHWAY 86 AND TOPAWA ROAD
Practice Address - Street 2:SELLS HOSPITAL
Practice Address - City:SELLS
Practice Address - State:AZ
Practice Address - Zip Code:85634
Practice Address - Country:US
Practice Address - Phone:520-383-7410
Practice Address - Fax:520-383-7255
Is Sole Proprietor?:No
Enumeration Date:2019-01-24
Last Update Date:2019-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201600657RN163W00000X
AZRN193691163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse