Provider Demographics
NPI:1336807890
Name:HARPER, MARYBETH (PHMNP-BC)
Entity type:Individual
Prefix:
First Name:MARYBETH
Middle Name:
Last Name:HARPER
Suffix:
Gender:F
Credentials:PHMNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1545 PLAZA DOMINGUIN
Mailing Address - Street 2:
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85635-4643
Mailing Address - Country:US
Mailing Address - Phone:520-234-4452
Mailing Address - Fax:
Practice Address - Street 1:4151 LA LINDA WAY STE 102
Practice Address - Street 2:
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635-4600
Practice Address - Country:US
Practice Address - Phone:520-515-9610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-02
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ266618363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health