| NPI | 1720699788 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SANDRA NICOLE DINWIDDIE Owner 623-439-5585 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner |
| Additional Taxonomies | 163WP0000X Registered Nurse, Pain Management |
| 363LA2200X Nurse Practitioner, Adult Health | |
| 363LG0600X Nurse Practitioner, Gerontology | |
| Enumeration Date | 2020-08-13 |
| Last Update Date | 2020-10-09 |