Provider Demographics
NPI:1780609461
Name:BOTHWELL, MURRYELLE (NP)
Entity type:Individual
Prefix:MS
First Name:MURRYELLE
Middle Name:
Last Name:BOTHWELL
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 1:2011 TIFFANY PL
Mailing Address - Street 2:
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85635-4129
Mailing Address - Country:US
Mailing Address - Phone:520-459-3970
Mailing Address - Fax:
Practice Address - Street 1:25 EL CAMINO REAL
Practice Address - Street 2:SUITE 4
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635-2800
Practice Address - Country:US
Practice Address - Phone:520-417-0996
Practice Address - Fax:520-417-2042
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN051269363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZS31033Medicare UPIN