Provider Demographics
NPI:1891783338
Name:NORDMAN, ROBERT (PA)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:NORDMAN
Suffix:
Gender:M
Credentials:PA
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8 E COTTONWOOD ST BLDG A
Mailing Address - Street 2:VERDE VALLEY GUIDANCE CLINIC
Mailing Address - City:COTTONWOOD
Mailing Address - State:AZ
Mailing Address - Zip Code:86326-6237
Mailing Address - Country:US
Mailing Address - Phone:928-634-2236
Mailing Address - Fax:928-634-8960
Practice Address - Street 1:8 E COTTONWOOD ST BLDG C
Practice Address - Street 2:VERDE VALLEY GUIDANCE CLINIC
Practice Address - City:COTTONWOOD
Practice Address - State:AZ
Practice Address - Zip Code:86326-6237
Practice Address - Country:US
Practice Address - Phone:928-634-2236
Practice Address - Fax:928-634-8960
Is Sole Proprietor?:No
Enumeration Date:2005-10-10
Last Update Date:2014-03-31
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI5601003838363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
P76925Medicare UPIN
MIN29180P03Medicare ID - Type Unspecified