| NPI | 1801577648 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AKANINYENE JAMES ETUKUDOH Clinical Director/ Practitioner 623-455-1558 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health |
| Additional Taxonomies | 261Q00000X Clinic/Center |
| 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) | |
| Enumeration Date | 2023-07-25 |
| Last Update Date | 2023-07-25 |