Organization
QUALITY OUTLOOK
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARLA CLAY LPN (LPN)
(602) 461-5330
Entity
Organization
Contact information
Practice address
1717 W GLENDALE AVE APT 3011, PHOENIX, AZ 85021-8817
(602) 461-5330
Mailing address
1717 W GLENDALE AVE APT 3011, PHOENIX, AZ 85021-8817
(602) 461-5330
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
LP046141
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1568980779
—
AZ
Enumeration date
10/20/2017
Last updated
10/20/2017
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