Doctor Name: | ANNIE MARIE RODMAN |
NPI Number: | 1275837932 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MSN/FNP |
License Number: | RN094835 AP1618 |
Business Practice Address: | 1510 E Wagon Wheel Ln Suite 106 Fort Mohave, AZ - 864266697 |
Business Phone Number: | 9287889378 |
Business Fax Number: | 9287889381 |
Mailing Address: | 1510 E Wagon Wheel Ln, Suite 106 FORT MOHAVE |
State: | AZ |
Postal Code: | 864266697 |
Phone Number: | 9287889378 |
Fax Number: | 9287889381 |
NPI Enumeration Date: | 01/10/2011 |
NPI Last Update Date: | 01/10/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | RN094835 AP1618 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | AZ |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |