| Blue River Health & Wellness, Pllc | |
|
1520 E Hammer Ln Ste 104 Fort Mohave AZ 86426-6665 | |
| (602) 315-0211 | |
| Not Available |
| Full Name | Blue River Health & Wellness, Pllc |
|---|---|
| Speciality | Nurse Practitioner |
| Location | 1520 E Hammer Ln Ste 104, Fort Mohave, Arizona |
| Authorized Official Name and Position | Nicole Ann Roberts (OWNER) |
| Authorized Official Contact | 9285772727 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Blue River Health & Wellness, Pllc Po Box 10739 Fort Mohave AZ 86427-0739 Ph: (928) 577-2727 | Blue River Health & Wellness, Pllc 1520 E Hammer Ln Ste 104 Fort Mohave AZ 86426-6665 Ph: (602) 315-0211 |
| NPI Number | 1356073852 |
|---|---|
| Provider Enumeration Date | 06/24/2022 |
| Last Update Date | 06/24/2022 |
| Medicare PECOS PAC ID | 8325429350 |
|---|---|
| Medicare Enrollment ID | O20220721001592 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1356073852 | NPI | - | NPPES |
| 23375081 | Other | AZ | CORPORATION ID |
| Provider Name | Nicole A Roberts |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1972158624 PECOS PAC ID: 3678901790 Enrollment ID: I20200723000990 |
| Provider Name | Jessica M Mormann |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1619626363 PECOS PAC ID: 4789069097 Enrollment ID: I20220921003775 |
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