Provider Demographics
NPI:1528491131
Name:KARAMBIZI, MARYLOU (NP)
Entity type:Individual
Prefix:MS
First Name:MARYLOU
Middle Name:
Last Name:KARAMBIZI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 860
Mailing Address - Street 2:200 HOSPITAL DRIVE
Mailing Address - City:WHITERIVER
Mailing Address - State:AZ
Mailing Address - Zip Code:85941-0860
Mailing Address - Country:US
Mailing Address - Phone:928-338-4911
Mailing Address - Fax:
Practice Address - Street 1:200 HOSPITAL DRIVE
Practice Address - Street 2:
Practice Address - City:WHITERIVER
Practice Address - State:AZ
Practice Address - Zip Code:85941-0860
Practice Address - Country:US
Practice Address - Phone:928-338-4911
Practice Address - Fax:928-338-5508
Is Sole Proprietor?:No
Enumeration Date:2013-08-19
Last Update Date:2014-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN199760363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MARN199760OtherNP LICENSE
AZ020561Medicaid
KS44922OtherNP LICENSE
AZ851791Medicaid
HSZ241Medicare PIN
MARN199760OtherNP LICENSE
030113Medicare Oscar/Certification