| NPI | 1295009561 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEPRA L JACK Director Of Operations 602-402-5090 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: AZ ap3059) |
| Enumeration Date | 2012-03-02 |
| Last Update Date | 2013-04-02 |