| NPI | 1336788868 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN W WILSON Business Manager 602-418-9105 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2020-01-01 |
| Last Update Date | 2021-06-21 |