Organization Name: | SONORA FAMILY CARE |
NPI Number: | 1083984694 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | KIRSTEN WISTER (OWNER) |
Mailing Address: | 77 Calle Portal Ste C240 Sierra Vista |
State: | AZ US |
Postal Code: | 856352986 |
Phone Number: | 5203356271 |
Fax Number: | 5203356316 |
NPI Enumeration Date: | 01/12/2012 |
NPI Last Update Date: | 02/19/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | AP3956 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | AZ |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |