Provider Demographics
NPI:1538167291
Name:ELDREDGE, NANCY M (PHD)
Entity type:Individual
Prefix:DR
First Name:NANCY
Middle Name:M
Last Name:ELDREDGE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 85684
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85754-5684
Mailing Address - Country:US
Mailing Address - Phone:502-622-4950
Mailing Address - Fax:520-622-1227
Practice Address - Street 1:377 S MEYER AVE
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85701-2231
Practice Address - Country:US
Practice Address - Phone:502-622-4950
Practice Address - Fax:520-622-1227
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-07
Last Update Date:2007-07-10
Deactivation Date:2006-03-15
Deactivation Code:
Reactivation Date:2006-03-29
Provider Licenses
StateLicense IDTaxonomies
AZ1684103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ143694OtherAHCCCS