Individual
MRS. HANEELIA JEAN MAX
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
322 HWY 160, SUITE #13, TUBA CITY, AZ 86045-2489
(928) 283-5206
(928) 283-5733
Mailing address
PO BOX 2489, TUBA CITY, AZ 86045-2489
(928) 283-5206
(928) 283-5733
Taxonomy
Speciality
Code
Description
License number
State
156F00000X
Technician/Technologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
119596
—
AZ
Enumeration date
04/02/2008
Last updated
04/02/2008
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