| NPI | 1174399497 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFFREY JAY HOSTETLER Practice Manager 623-734-7605 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2023-11-28 |
| Last Update Date | 2023-11-28 |