| NPI | 1609206549 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEREMY R BUCKNER Owner 602-421-2730 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: AZ 5988) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: AZ AP4986) |
| 364SF0001X Clinical Nurse Specialist, Family Health (Licence: AZ AP2828) | |
| Enumeration Date | 2013-11-13 |
| Last Update Date | 2013-11-13 |