| NPI | 1376973461 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEPHANIE PETERSON Supervisor, Provider Enrollment 480-862-1677 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner |
| Additional Taxonomies | 207R00000X Internal Medicine |
| 207W00000X Ophthalmology | |
| 2085R0202X Radiology, Diagnostic Radiology | |
| Enumeration Date | 2013-11-26 |
| Last Update Date | 2021-10-27 |