| NPI | 1639433063 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEPHANIE PETERSON Supervisor, Provider Enrollment 480-862-1677 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner |
| Enumeration Date | 2012-06-29 |
| Last Update Date | 2021-10-06 |