BLUE RIVER HEALTH & WELLNESS PLLC NPI 1356073852

NPI Information

NPI: 1356073852
Provider Name: BLUE RIVER HEALTH & WELLNESS, PLLC
Classification: Nurse Practitioner - 363LF0000X
Entity Type: Organization

Specialization: Family

CLIA Number: 03D2267796

Address:
1520 E HAMMER LN STE 104
FORT MOHAVE, AZ
ZIP 86426
Phone: (602) 315-0211
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BLUE RIVER HEALTH & WELLNESS, PLLC is a family nurse practitioner in Fort Mohave, AZ. BLUE RIVER HEALTH & WELLNESS, PLLC NPI is 1356073852. The provider is registered as an organization entity type.

The provider's business location address is:

1520 E HAMMER LN STE 104
FORT MOHAVE, AZ
ZIP 86426-665
Phone: (602) 315-0211

The provider's authorized official is Nicole Ann Roberts .
The authorized official title is Owner and has the following contact phone number (928) 577-2727.

The CLIA number assigned to this NPI record is 03D2267796 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 6/24/2022 and was last updated on 6/24/2022.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	Primary
1	261Q00000X	Clinic/Center		No
2	363LP0808X	Nurse Practitioner	Psychiatric/Mental Health	No
3	363LP2300X	Nurse Practitioner	Primary Care	No
4	363LF0000X	Nurse Practitioner	Family	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	23375081	OTHER	ARIZONA	CORPORATION ID

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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