| NPI | 1609169259 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEPHANIE PETERSON Supervisor, Provider Enrollment 480-862-1677 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health |
| Enumeration Date | 2011-05-16 |
| Last Update Date | 2021-09-27 |