| NPI | 1861003121 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CONNIE DECKER Credentialing Manager 480-269-2971 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2020-08-11 |
| Last Update Date | 2024-11-07 |