Provider Demographics
NPI:1821093477
Name:RICHARD, ANARESIA MARIE (FNP)
Entity Type:Individual
Prefix:MRS
First Name:ANARESIA
Middle Name:MARIE
Last Name:RICHARD
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10225 HARBOR AVE
Mailing Address - Street 2:STE 5
Mailing Address - City:MOHAVE VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86440-9699
Mailing Address - Country:US
Mailing Address - Phone:928-788-2373
Mailing Address - Fax:928-788-2374
Practice Address - Street 1:10225 HARBOR AVE
Practice Address - Street 2:STE 5
Practice Address - City:MOHAVE VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86440-9699
Practice Address - Country:US
Practice Address - Phone:928-788-2373
Practice Address - Fax:928-788-2374
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP1692363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZP83975Medicare UPIN