| NPI | 1518381060 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VICKI MANCUSO Office Administrator 480-510-3567 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: AZ AP3870) |
| Enumeration Date | 2014-02-04 |
| Last Update Date | 2014-02-04 |