Basic Information
| Provider Information | |||||||||
| NPI: | 1780953158 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LAND | ||||||||
| FirstName: | JOSEPH | ||||||||
| MiddleName: | DEAN | ||||||||
| NamePrefix: | |||||||||
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| Credential: | RN | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1458 | ||||||||
| Address2: | |||||||||
| City: | TUBA CITY | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 860451458 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2487018799 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 167 NORTH MAIN STREET | ||||||||
| Address2: | |||||||||
| City: | TUBA CITY | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 86045 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9282832781 | ||||||||
| FaxNumber: | 9282832677 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/14/2011 | ||||||||
| LastUpdateDate: | 12/14/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 4704284850 | MI | Y | Nursing Service Providers | Registered Nurse |
No ID Information.