| NPI | 1114332988 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEVE WICKLUND Manager 602-889-5833 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| Enumeration Date | 2014-06-30 |
| Last Update Date | 2015-05-14 |