Organization
LIFETIME MEDICAL CARE PLLC
Active
Organization
LIFETIME MEDICAL CARE PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SHELLY DAMSCHRODER FNP (MANAGER/OWNER/PROVIDER)
(928) 237-9014
Entity
Organization
Contact information
Practice address
3101 CLEARWATER DR, SUITE B, PRESCOTT, AZ 86305-7180
(928) 237-9014
(928) 237-9063
Mailing address
3101 CLEARWATER DR, SUITE B, PRESCOTT, AZ 86305-7180
(928) 237-9014
(928) 237-9063
Taxonomy
Speciality
Code
Description
License number
State
261QR1300X
Rural Health Clinic/Center
Primary
AP7289
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
AP7289
NURSE PRACTITIONER LICENSE NUMBER
AZ
Enumeration date
07/24/2014
Last updated
01/04/2015
Update your record
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