Organization
INNOVATIVE PRIMARY CARE CLINIC OF HAVASU PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. JACQUELYN J. MEYER N.P. (PRESIDENT)
(928) 854-7666
Entity
Organization
Contact information
Practice address
297 LAKE HAVASU AVE S, SUITE 106, LAKE HAVASU CITY, AZ 86403-6526
(928) 854-7666
(928) 854-7660
Mailing address
PO BOX 27340, PHOENIX, AZ 85061-7340
(602) 943-9200
(602) 216-3000
Taxonomy
Speciality
Code
Description
License number
State
363LP2300X
Primary Care Nurse Practitioner
Primary
AP1654
AZ
Other
Enumeration date
08/15/2013
Last updated
08/16/2013
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