| NPI | 1326596719 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CONNIE DECKER Credentialing Manage 480-269-2971 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical |
| 207Q00000X Family Medicine | |
| 207QA0401X Family Medicine, Addiction Medicine | |
| 207R00000X Internal Medicine | |
| 207RA0401X Internal Medicine, Addiction Medicine | |
| 208000000X Pediatrics | |
| 2080A0000X Pediatrics, Adolescent Medicine | |
| 363L00000X Nurse Practitioner | |
| 363LF0000X Nurse Practitioner, Family | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health | |
| 363LP2300X Nurse Practitioner, Primary Care | |
| Enumeration Date | 2016-09-14 |
| Last Update Date | 2022-05-17 |