Provider Demographics
NPI:1902178833
Name:RAWLS, ELIZABETH (RN)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:RAWLS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 860
Mailing Address - Street 2:
Mailing Address - City:FORT DEFIANCE
Mailing Address - State:AZ
Mailing Address - Zip Code:86504-0860
Mailing Address - Country:US
Mailing Address - Phone:928-729-8525
Mailing Address - Fax:
Practice Address - Street 1:NAVAJO RT 12 AND N 7
Practice Address - Street 2:
Practice Address - City:FT DEFIANCE
Practice Address - State:AZ
Practice Address - Zip Code:86504
Practice Address - Country:US
Practice Address - Phone:928-729-8525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-08
Last Update Date:2012-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK24173163WD0400X, 171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator
No171M00000XOther Service ProvidersCase Manager/Care Coordinator