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1417617002
IRINA KHAKHANOV
PHOENIX, AZ
NPI
1417617002
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
Yes
Primary Taxonomy
363LF0000X Nurse Practitioner, Family
(Licence: AZ f11210467)
Enumeration Date
2021-12-22
Last Update Date
2021-12-22
Business Address
IRINA KHAKHANOV
5777 E MAYO BLVD
PHOENIX, AZ 85054-4502
Phone number: 646-249-5910
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Mailing Address
IRINA KHAKHANOV
15437 N 13TH AVE
PHOENIX, AZ 85023-4484
Phone number: 646-249-5910
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