DOROTHY RUTH GRANBERRY , NPI 1811323934 — PHOENIX (AZ)

NPI 1811323934

6+ Years Experience Individual

DOROTHY RUTH GRANBERRY

09/20/2013
PROVIDER ENUMERATION DATE
09/20/2013
LAST UPDATE DATE
1811323934
NPI NUMBER

About DOROTHY RUTH GRANBERRY

Sole proprietor? No, Entity Type 1 Provider (Individual) is not a Sole Proprietor.

DOROTHY RUTH GRANBERRY is a provider established in PHOENIX, AZ. The NPI number of DOROTHY RUTH GRANBERRY is 1811323934 and was assigned on 09/20/2013. The practitioners primary taxonomy code is: 247200000X AZ .

Mailing address

  • City: PHOENIX
  • State: AZ
  • Postal code: 850237102
  • Phone: 4803475702
  • Fax: 6022520830
  • Address: 14602 N 19TH AVE
  • Address 2: 148

Primary Practice Address

  • Region : PHOENIX, AZ
  • NPI : 1811323934
  • Phone : 6022549701
  • Fax : 6022520830
  • Postalcode : 850155101
  • Address : 4220 N 20TH AVE 100

Provider taxonomy - Technician, Other

  • Taxonomy code: 247200000X
  • License state: AZ

The taxonomy is the primary taxonomy (there can be only one per NPI record).

Taxonomy description: A collective term for persons with specialized training in various narrow fields of expertise whose occupations require training and skills in specific technical processes and procedures; and where further classification is deemed unnecessary by the user.

Contacts:

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  • DOROTHY RUTH GRANBERRY
  • Address : 4220 N 20TH AVE 100
  • Region : PHOENIX, AZ
  • NPI : 1811323934
  • Phone : 6022549701
  • Fax : 6022520830
  • Postalcode : 850155101

Reference NPI Information. Full replica of the CMS (NPPES) NPI record

Field Name Value
Provider First Line Business Practice Location Address4220 N 20TH AVE
The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Second Line Business Practice Location Address100
The second line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Business Practice Location Address City NamePHOENIX
The city name in the location address of the provider being identified.
Provider Business Practice Location Address State NameAZ
The State or Province name in the location address of the provider being identified.
Provider Business Practice Location Address Postal Code850155101
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Business Practice Location Address Telephone Number6022549701
The telephone number associated with the location address of the provider being identified.
Provider Business Practice Location Address Fax Number6022520830
The fax number associated with the location address of the provider being identified.
NPI1811323934
10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider.
Healthcare Provider Taxonomy 1247200000X
A collective term for persons with specialized training in various narrow fields of expertise whose occupations require training and skills in specific technical processes and procedures; and where further classification is deemed unnecessary by the user.
Provider Enumeration Date09/20/2013
The date the provider was assigned a unique identifier (assigned an NPI).
Last Updated09/20/2013
The date that a record was last updated or changed.
Entity TypeIndividual
Code describing the type of health care provider that is being assigned an NPI. Codes are:
  • 1 = (Person): individual human being who furnishes health care;
  • 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
Provider Organization Name (Legal Business Name)DOROTHY RUTH GRANBERRY
Provide organization name (legal business name used to file tax returns with the IRS). The Organization Name field allows the following special characters: ampersand, apostrophe, "at" sign, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters.
Provider First Line Business Mailing Address14602 N 19TH AVE
The first line mailing address of the provider being identified. This data element may contain the same information as "Provider first line location address".
Provider Second Line Business Mailing Address148
The second line mailing address of the provider being identified. This data element may contain the same information as "Provider second line location address".
Provider Business Mailing Address City NamePHOENIX
The City name in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address City name".
Provider Business Mailing Address State NameAZ
The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address State name".
Provider Business Mailing Address Postal Code850237102
The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as "Provider location address postal code".
Provider Business Mailing Address Telephone Number4803475702
The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as "Provider location address telephone number".
Provider Business Mailing Address Fax Number6022520830
The fax number associated with the mailing address of the provider being identified. This data element may contain the same information as "Provider location address fax number".
Healthcare Provider Taxonomy Code #1247200000X
The Health Care Provider Taxonomy code is a unique alphanumeric code, ten characters in length. The code set is structured into three distinct "Levels" including Provider Type, Classification, and Area of Specialization.
Healthcare Provider Taxonomy 1Technician, Other
A collective term for persons with specialized training in various narrow fields of expertise whose occupations require training and skills in specific technical processes and procedures; and where further classification is deemed unnecessary by the user.
Provider License Number State Code 1AZ
Healthcare Provider Primary Taxonomy Switch 1Y
Primary Taxonomy:
  • X - The primary taxonomy switch is Not Answered;
  • Y - The taxonomy is the primary taxonomy (there can be only one per NPI record);
  • N - The taxonomy is not the primary taxonomy.
Provider Gender CodeF
  • M - male
  • F - female
Is sole proprietorN
  • X - Not Answered
  • Y - Yes, Entity Type 1 Provider (Individual) is a Sole Proprietor
  • N - No, Entity Type 1 Provider (Individual) is not a Sole Proprietor
X

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