Provider Demographics
NPI:1396490280
Name:DRAKE, NADIA
Entity type:Individual
Prefix:
First Name:NADIA
Middle Name:
Last Name:DRAKE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NADIA
Other - Middle Name:
Other - Last Name:WILLOUGHBY DRAKE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MBA
Mailing Address - Street 1:3702 E CAMELBACK RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-2508
Mailing Address - Country:US
Mailing Address - Phone:480-648-6446
Mailing Address - Fax:
Practice Address - Street 1:12020 S WARNER ELLIOT LOOP STE 124
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85044-2717
Practice Address - Country:US
Practice Address - Phone:480-744-1950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-18
Last Update Date:2022-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ03D2212772247ZC0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247ZC0005XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyClinical Laboratory Director, Non-physician