Provider Demographics
NPI:1518260645
Name:VALLEY OF THE SUN PROFESSIONAL
Entity Type:Organization
Organization Name:VALLEY OF THE SUN PROFESSIONAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIAN
Authorized Official - Middle Name:JOY
Authorized Official - Last Name:REMINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:ANP
Authorized Official - Phone:623-933-5991
Mailing Address - Street 1:19630 N WILLOW CREEK CIR
Mailing Address - Street 2:
Mailing Address - City:SUN CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:85373-1234
Mailing Address - Country:US
Mailing Address - Phone:623-933-5991
Mailing Address - Fax:623-933-5991
Practice Address - Street 1:19630 N WILLOW CREEK CIR
Practice Address - Street 2:
Practice Address - City:SUN CITY
Practice Address - State:AZ
Practice Address - Zip Code:85373-1234
Practice Address - Country:US
Practice Address - Phone:623-933-5991
Practice Address - Fax:623-933-5991
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-11
Last Update Date:2015-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP-0056363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1689666943Medicare UPIN