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Prairie View Creations Llc

Prairie View Creations Llc is a health care provider in Prescott, AZ. In this page you will find its mailing address, practice location, phone number, specialty etc.

physician-icon Basic Information

Practice Location 8508 N Prairie Vw, Prescott Valley, AZ 86315-9089, US
Practice Location Phone928-772-8652
Practice Location Fax928-772-8078
Legal Business NamePRAIRIE VIEW CREATIONS LLC
NPI ?1063979961
Entity TypeOrganization
Enumeration Date ? Feb 27, 2019
Last Update Date ? Feb 27, 2019
Note:
NPI: National Provider Identifier issued to health care providers by Centers for Medicare and Medicaid Services (CMS).

specialty-icon Specialties & Licenses of Prairie View Creations Llc

SpecialtySpecializationLicenseLicense State
Dietitian, Registered
Dietitian, RegisteredNutrition, Pediatric
Dietitian, RegisteredNutrition, Renal
Dietitian, RegisteredNutrition, Metabolic

legacy-id-icon Legacy Provider IDs of Prairie View Creations Llc

Provider IdIssuer StateIssuer TypeIssuer
488506ArizonaMedicaid

official-icon Authorized Official of Prairie View Creations Llc

An authorized official is an appointed official with the legal authority to make changes and/or updates to the Prairie View Creations Llc's status and to commit the provider to fully abide by the laws and regulations relating to the National Provider Identifier (NPI).

Authorized Official Chad Hetherwick (MS, RD)
Authorized Official Title/PositionREGISTERED DIETITIAN NUTRITIONIST
Authorized Official Phone Number928-772-8652