Provider Demographics
NPI:1780913236
Name:MCNAIR, WILLIAM RUSSELL (FNP)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:RUSSELL
Last Name:MCNAIR
Suffix:
Gender:M
Credentials:FNP
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 617
Mailing Address - Street 2:
Mailing Address - City:SOMERTON
Mailing Address - State:AZ
Mailing Address - Zip Code:85350-0617
Mailing Address - Country:US
Mailing Address - Phone:928-662-0406
Mailing Address - Fax:
Practice Address - Street 1:1896 E. BABBIT LN
Practice Address - Street 2:
Practice Address - City:SAN LUIS
Practice Address - State:AZ
Practice Address - Zip Code:85349
Practice Address - Country:US
Practice Address - Phone:928-627-9222
Practice Address - Fax:928-627-8315
Is Sole Proprietor?:No
Enumeration Date:2009-12-11
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN160158363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ503006Medicaid
AZZ137149OtherMEDICARE
AZZ137149Medicare UPIN