Provider Demographics
NPI:1801417860
Name:HEALTH AND HEALING CLINIC
Entity type:Organization
Organization Name:HEALTH AND HEALING CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FABIOLA
Authorized Official - Middle Name:
Authorized Official - Last Name:MERCHANT
Authorized Official - Suffix:
Authorized Official - Credentials:CNM
Authorized Official - Phone:928-821-8471
Mailing Address - Street 1:2044 RED ROCK LOOP RD
Mailing Address - Street 2:
Mailing Address - City:SEDONA
Mailing Address - State:AZ
Mailing Address - Zip Code:86336-9120
Mailing Address - Country:US
Mailing Address - Phone:928-821-8471
Mailing Address - Fax:
Practice Address - Street 1:2044 RED ROCK LOOP RD
Practice Address - Street 2:
Practice Address - City:SEDONA
Practice Address - State:AZ
Practice Address - Zip Code:86336-9120
Practice Address - Country:US
Practice Address - Phone:928-821-8471
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-30
Last Update Date:2020-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1629546601Medicaid