Provider Demographics
NPI:1891088803
Name:DESERT SKY FAMILY CLINIC OF YUMA
Entity Type:Organization
Organization Name:DESERT SKY FAMILY CLINIC OF YUMA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY NURSE PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANA
Authorized Official - Middle Name:M
Authorized Official - Last Name:RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:MSN, FNP-C
Authorized Official - Phone:928-783-0919
Mailing Address - Street 1:2180 S 4TH AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-6478
Mailing Address - Country:US
Mailing Address - Phone:928-783-0919
Mailing Address - Fax:
Practice Address - Street 1:2180 S 4TH AVE
Practice Address - Street 2:SUITE A
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-6478
Practice Address - Country:US
Practice Address - Phone:928-783-0919
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-24
Last Update Date:2011-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP 1944363LF0000X
AZAP 3602363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZNPI 1720138415OtherNATIONAL PROVIDER IDENTIFIER
AZNPI 1992013122OtherNATIONAL PROVIDER IDENFIFICATION