Individual
VIVIAN SEVILLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CNA, LMT
Contact information
Practice address
6152 W. HARDSCRABBLE ROAD, PINE, AZ 85544
(928) 978-2618
(928) 476-3186
Mailing address
PO BOX 2453, PINE, AZ 85544-2453
(928) 978-2618
(928) 476-3186
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
MT-02072P
AZ
Other
Enumeration date
11/23/2007
Last updated
11/23/2007
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