Provider Demographics
NPI:1437661212
Name:R&N FAMILY MEDICAL PRACTICE LLC
Entity Type:Organization
Organization Name:R&N FAMILY MEDICAL PRACTICE LLC
Other - Org Name:MARYVALE FAMILY PRACTICE GROUP INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FNP
Authorized Official - Prefix:
Authorized Official - First Name:NAHLA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHIRCO
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:248-250-3146
Mailing Address - Street 1:4700 N 51ST AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85031-1237
Mailing Address - Country:US
Mailing Address - Phone:623-209-5555
Mailing Address - Fax:623-247-1905
Practice Address - Street 1:4700 N 51ST AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85031-1237
Practice Address - Country:US
Practice Address - Phone:623-209-5555
Practice Address - Fax:623-247-1905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-01
Last Update Date:2017-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1750518395OtherNPI