Provider Demographics
NPI:1245677921
Name:CLYNE, NANCY DIANN (NP)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:DIANN
Last Name:CLYNE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10496 N WHITE FAWN RD
Mailing Address - Street 2:
Mailing Address - City:ELFRIDA
Mailing Address - State:AZ
Mailing Address - Zip Code:85610-9118
Mailing Address - Country:US
Mailing Address - Phone:520-642-1441
Mailing Address - Fax:520-642-1441
Practice Address - Street 1:10496 N WHITE FAWN RD
Practice Address - Street 2:
Practice Address - City:ELFRIDA
Practice Address - State:AZ
Practice Address - Zip Code:85610-9118
Practice Address - Country:US
Practice Address - Phone:520-642-1441
Practice Address - Fax:520-642-1441
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-04
Last Update Date:2013-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP3037363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health