Organization Name: | UNITED STATES AIR FORCE |
NPI Number: | 1720071608 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | PATTI JO PETERSON-BALLIET (PEDIATRIC NURSE PRACTITIONER) |
Mailing Address: | 7219 N Litchfield Rd Luke Afb |
State: | AZ US |
Postal Code: | 853091529 |
Phone Number: | 6238569725 |
Fax Number: | 6238567567 |
NPI Enumeration Date: | 08/25/2005 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 286500000X |
License Number: | RN114749 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | AZ |
Taxonomy Type: | Hospitals |
Taxonomy Classification: | Military Hospital |
Taxonomy Specialization: | |
Taxonomy Definition: | A health care facility operated by the Department of Defense. |