Provider Demographics
NPI:1801325428
Name:ARNOLD, JOAN
Entity type:Individual
Prefix:
First Name:JOAN
Middle Name:
Last Name:ARNOLD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11353 W SMOOTH PUMICE ST
Mailing Address - Street 2:
Mailing Address - City:MARANA
Mailing Address - State:AZ
Mailing Address - Zip Code:85658-4589
Mailing Address - Country:US
Mailing Address - Phone:520-448-8135
Mailing Address - Fax:
Practice Address - Street 1:11353 W SMOOTH PUMICE ST
Practice Address - Street 2:
Practice Address - City:MARANA
Practice Address - State:AZ
Practice Address - Zip Code:85658-4589
Practice Address - Country:US
Practice Address - Phone:520-448-8135
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-07
Last Update Date:2017-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBH5140385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZBH5140OtherAZ EPT OF HEALTH SERVICES