| NPI | 1104111848 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JR WADE Member 480-229-1986 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: AZ AP3397) |
| Enumeration Date | 2011-06-10 |
| Last Update Date | 2011-06-10 |