Individual
PEARL KLOAC
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
US HWY 98 & NAVAJO ROUTE 16, 7397, SHONTO, AZ 86054
(928) 672-3000
(928) 672-3062
Mailing address
HC 70 BOX 7397, SHONTO, AZ 86054
(928) 672-3057
(928) 672-3062
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
4704119567
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
494458
—
AZ
01
—
8HL079
MEDICARE WR
AZ
01
—
8HL080
MEDICARE CBQ
AZ
Enumeration date
10/04/2006
Last updated
01/10/2019
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