Individual
PRESTON MASAYUMPTEWA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RN
Contact information
Practice address
HWY 264 MMP 388, POLACCA, AZ 86042-4000
(928) 737-6372
(928) 737-6369
Mailing address
PO BOX 4000, POLACCA, AZ 86042-4000
(928) 737-6372
(928) 737-6369
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
RN129290
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
020529
—
AZ
Enumeration date
07/26/2010
Last updated
07/26/2010
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