Provider Demographics
NPI:1871811802
Name:NKL NEUROLOGY PLC
Entity type:Organization
Organization Name:NKL NEUROLOGY PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:NIDA
Authorized Official - Middle Name:K
Authorized Official - Last Name:LAURIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-779-3997
Mailing Address - Street 1:9817 N 95TH ST STE 110
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-4587
Mailing Address - Country:US
Mailing Address - Phone:480-779-3997
Mailing Address - Fax:480-779-1305
Practice Address - Street 1:9817 N 95TH ST STE 110
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-4587
Practice Address - Country:US
Practice Address - Phone:480-779-3997
Practice Address - Fax:480-779-1305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-14
Last Update Date:2012-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ35284174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ955263Medicaid
AZ955263Medicaid