Organization
COUNTRY CLUB MEDICAL WEIGHT LOSS & WELLNESS PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. FLORA ISSANDA STOWATER NP (OWNER/MANAGER)
(480) 840-4777
Entity
Organization
Contact information
Practice address
1855 S COUNTRY CLUB DR STE 111-130, MESA, AZ 85210-6037
(480) 840-4777
Mailing address
PO BOX 697, LAVEEN, AZ 85339-0697
(480) 840-4777
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
—
—
Other
Enumeration date
10/05/2023
Last updated
10/05/2023
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