| Azlivedoctor.com | |
|
7252 W St Catherine Ave Laveen AZ 85339-2693 | |
| (480) 788-0240 | |
| Not Available |
| Full Name | Azlivedoctor.com |
|---|---|
| Speciality | Family Medicine |
| Location | 7252 W St Catherine Ave, Laveen, Arizona |
| Authorized Official Name and Position | Nelson Mcnova Bryant (CO-CHAIR/CHIEF OPERATING OFFICER) |
| Authorized Official Contact | 4807880240 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Azlivedoctor.com 7252 W St Catherine Ave Laveen AZ 85339-2693 Ph: (480) 788-0240 | Azlivedoctor.com 7252 W St Catherine Ave Laveen AZ 85339-2693 Ph: (480) 788-0240 |
| NPI Number | 1487307013 |
|---|---|
| Provider Enumeration Date | 02/02/2022 |
| Last Update Date | 07/07/2024 |
| Medicare PECOS PAC ID | 8325422785 |
|---|---|
| Medicare Enrollment ID | O20220902000602 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1487307013 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Secondary |
| Provider Name | Nilah Bryant |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1518539550 PECOS PAC ID: 6103223516 Enrollment ID: I20210928003021 |
| Provider Name | Nelson Bryant |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1215584818 PECOS PAC ID: 0941695597 Enrollment ID: I20220316004003 |
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