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Individual

KATHERINE ELAINE TAVARES

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
FNP-BC

Contact information

Practice address
103 MEDICINE WAY RD, PERIDOT, AZ 85542-5000
(928) 475-1400
Mailing address
PO BOX 2406, CLAYPOOL, AZ 85532-2406
(928) 961-0159

Taxonomy

Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN105209
AZ
363LP2300X
Primary Care Nurse Practitioner
Primary
279367
AZ

Other

Enumeration date
08/09/2022
Last updated
08/16/2022
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