Provider Demographics
NPI:1558795062
Name:FLAGSTAFF UNIFIED SCHOOL DISTRICT
Entity Type:Organization
Organization Name:FLAGSTAFF UNIFIED SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RN, SCHOOL NURSE
Authorized Official - Prefix:
Authorized Official - First Name:GRETCHEN
Authorized Official - Middle Name:KATE
Authorized Official - Last Name:LERCH
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:928-773-4092
Mailing Address - Street 1:3401 N 4TH ST
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86004-1710
Mailing Address - Country:US
Mailing Address - Phone:928-773-4092
Mailing Address - Fax:
Practice Address - Street 1:3401 N 4TH ST
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86004-1710
Practice Address - Country:US
Practice Address - Phone:928-773-4092
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-03
Last Update Date:2013-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN164044313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility