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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
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