Doctor Name: | MARK CHARLES PRIOLA |
NPI Number: | 1407161235 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | FNP-C |
License Number: | AP3629 |
Business Practice Address: | 474 N State Route 89 Chino Valley, AZ - 863235993 |
Business Phone Number: | 9286364355 |
Business Fax Number: | 9286360754 |
Mailing Address: | 13305 N Yaqui Dr, PRESCOTT |
State: | AZ |
Postal Code: | 863054599 |
Phone Number: | 9285154549 |
Fax Number: | 9287080255 |
NPI Enumeration Date: | 08/17/2010 |
NPI Last Update Date: | 07/28/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | AP3629 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | AZ |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |