Active NPI
Patricia Nadurak
- Family Nurse Practitioner
- Fort Defiance, AZ
National Provider Identifier
1134203359
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- R45163
- Practice address
- Corner of N12 and N8
Fort Defiance, AZ 86504 - Phone
- (928) 729-8000
- NPI assigned
- Oct 24, 2006
- Last updated
- Jul 8, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | R45163 | NM | Primary |
Addresses
Primary practice location
Corner of N12 and N8
Fort Defiance, AZ 86504
Mailing address
PO Box 1451
Dolores, CO 81323-1451
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 89181301 | Medicaid | NM | |
| 756679 | Medicaid | AZ |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R45163 | NM | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| DHHS PHS Naihs Fort Defiance Hospital | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba PHS Fort Defiance Indian Hospital
- General Acute Care Hospital
- Fort Defiance, AZ
- NPI 1700962131
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161648000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1134203359",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1451",
"city": "DOLORES",
"state": "CO",
"postal_code": "813231451"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "CORNER OF N12 AND N8",
"city": "FORT DEFIANCE",
"state": "AZ",
"postal_code": "86504",
"telephone_number": "928-729-8000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NADURAK",
"first_name": "PATRICIA",
"name_prefix": "Mrs.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-10-24",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "NM",
"license": "R45163",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "89181301",
"state": "NM"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "756679",
"state": "AZ"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Fort Defiance, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.