Provider Demographics
NPI:1942369137
Name:PRESCOTT UNIFIED SCHOOL DISTRICT
Entity Type:Organization
Organization Name:PRESCOTT UNIFIED SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SCHOOL NURSE
Authorized Official - Prefix:MRS
Authorized Official - First Name:GINNY
Authorized Official - Middle Name:T
Authorized Official - Last Name:ELLEY
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:928-717-3263
Mailing Address - Street 1:1116 SMOKI AVE
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86303-3426
Mailing Address - Country:US
Mailing Address - Phone:928-445-8624
Mailing Address - Fax:
Practice Address - Street 1:146 S GRANITE ST
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86303-4710
Practice Address - Country:US
Practice Address - Phone:928-445-5400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN 060461390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty