Individual
THAYLIA N/A QUANIMPTEWA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
HWY 264 MP388, POLACCA, AZ 86042
(928) 737-6000
(928) 737-6005
Mailing address
HWY 264 MP388, POLACCA, AZ 86042
(928) 737-6000
(928) 737-6005
Taxonomy
Speciality
Code
Description
License number
State
247000000X
Health Information Technician
Primary
1125148
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
020529
—
AZ
05
—
1125148
—
AZ
Enumeration date
08/09/2022
Last updated
08/09/2022
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