Provider Demographics
NPI:1427272285
Name:FURCHTBAR, MARGARET E (LPN)
Entity type:Individual
Prefix:MRS
First Name:MARGARET
Middle Name:E
Last Name:FURCHTBAR
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1175 E SUFFOCK AVE
Mailing Address - Street 2:
Mailing Address - City:KINGMAN
Mailing Address - State:AZ
Mailing Address - Zip Code:86409-1261
Mailing Address - Country:US
Mailing Address - Phone:928-757-9099
Mailing Address - Fax:
Practice Address - Street 1:500 MAPLE ST
Practice Address - Street 2:
Practice Address - City:KINGMAN
Practice Address - State:AZ
Practice Address - Zip Code:86401-5645
Practice Address - Country:US
Practice Address - Phone:928-753-2472
Practice Address - Fax:928-753-7895
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLP011854164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ561854Medicaid