Organization
SAN CARLOS APACHE TRIBE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. WENDSLER NOSIE (TRIBAL CHAIRMAN)
(928) 475-2361
Entity
Organization
Contact information
Practice address
1 MOHAVE AVENUE, SAN CARLOS, AZ 85550
(928) 475-2798
(928) 475-5925
Mailing address
PO BOX 0, SAN CARLOS, AZ 85550
(928) 475-2798
(928) 475-5925
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
85002233
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
153159
—
AZ
Enumeration date
03/14/2007
Last updated
08/22/2020
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