| NPI | 1811603202 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEPHANIE BLACKMORE Owner/ Nurse Practitioner 623-439-5176 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care |
| Additional Taxonomies | 363L00000X Nurse Practitioner |
| Enumeration Date | 2023-01-30 |
| Last Update Date | 2023-10-10 |