Organization
NUDERM TREATMENT CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOANN EASTMAN FNP-BC (OWNER/PRESIDENT)
(928) 453-7546
Entity
Organization
Contact information
Practice address
1840 MESQUITE AVE, SUITE B, LAKE HAVASU CITY, AZ 86403-5771
(928) 453-7546
(928) 453-3660
Mailing address
1840 MESQUITE AVE, SUITE B, LAKE HAVASU CITY, AZ 86403-5771
(928) 453-7546
(928) 453-3660
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
AP8759
AZ
Other
Enumeration date
10/02/2012
Last updated
08/03/2016
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