| NPI | 1104605757 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARLOTTE JENKINS Owner 480-600-2801 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Additional Taxonomies | 305R00000X Preferred Provider Organization |
| 363LF0000X Nurse Practitioner, Family | |
| Enumeration Date | 2023-09-25 |
| Last Update Date | 2024-04-26 |