Provider Demographics
NPI:1063137883
Name:NORTHERN ARIZONA HEALTHCARE
Entity type:Organization
Organization Name:NORTHERN ARIZONA HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:ELAINE
Authorized Official - Middle Name:MARY
Authorized Official - Last Name:ACCOMANDO
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:928-639-5580
Mailing Address - Street 1:340 S WILLARD ST
Mailing Address - Street 2:
Mailing Address - City:COTTONWOOD
Mailing Address - State:AZ
Mailing Address - Zip Code:86326-4126
Mailing Address - Country:US
Mailing Address - Phone:928-639-5580
Mailing Address - Fax:928-639-6541
Practice Address - Street 1:340 S WILLARD ST
Practice Address - Street 2:
Practice Address - City:COTTONWOOD
Practice Address - State:AZ
Practice Address - Zip Code:86326-4126
Practice Address - Country:US
Practice Address - Phone:928-639-5580
Practice Address - Fax:928-639-6541
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-04
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty