Provider Demographics
NPI:1487155909
Name:CURTIS, MAEBELLE
Entity type:Individual
Prefix:
First Name:MAEBELLE
Middle Name:
Last Name:CURTIS
Suffix:
Gender:F
Credentials:
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 7452
Mailing Address - Street 2:
Mailing Address - City:SHONTO
Mailing Address - State:AZ
Mailing Address - Zip Code:86054-7452
Mailing Address - Country:US
Mailing Address - Phone:928-209-3295
Mailing Address - Fax:
Practice Address - Street 1:HWY 98 ROUTE 6320 MP1
Practice Address - Street 2:
Practice Address - City:SHONTO
Practice Address - State:AZ
Practice Address - Zip Code:86054
Practice Address - Country:US
Practice Address - Phone:928-209-3295
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-21
Last Update Date:2018-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3747A0650X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider