Organization
COUNTRY CLINIC PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KATHERINE C HAKEMAN NP (PRESIDENT)
(480) 369-0582
Entity
Organization
Contact information
Practice address
26416 S MANDARIN DR, QUEEN CREEK, AZ 85142-9411
(480) 369-0582
(480) 279-4274
Mailing address
PO BOX 9277, CHANDLER HEIGHTS, AZ 85127-9277
(480) 369-0582
(480) 279-4274
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
AP2088
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
644363
—
AZ
Enumeration date
09/07/2011
Last updated
03/14/2012
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