Provider Demographics
NPI:1629444807
Name:FLAMINGARROW, DIVINA
Entity Type:Individual
Prefix:
First Name:DIVINA
Middle Name:
Last Name:FLAMINGARROW
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:GERLYN
Other - Middle Name:ANNE
Other - Last Name:BOEH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:960 N GILBERT RD
Mailing Address - Street 2:APT 218
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234-3319
Mailing Address - Country:US
Mailing Address - Phone:928-925-5887
Mailing Address - Fax:
Practice Address - Street 1:1025 N COUNTRY CLUB DR
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85201-3307
Practice Address - Country:US
Practice Address - Phone:480-472-0502
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-11
Last Update Date:2015-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLP037535164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse