Organization
PRESCOTT FAMILY PRACTICE AND WELLNESS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. STEPHANIE DIANE TEN EYCK NP (OWNER)
(480) 729-4939
Entity
Organization
Contact information
Practice address
1151 W IRON SPRINGS RD STE F, PRESCOTT, AZ 86305-1614
(928) 533-1136
Mailing address
608 VISTA DEL CERRO ST, PRESCOTT, AZ 86301-1059
(480) 729-4939
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
AP7670
AZ
Other
Enumeration date
08/16/2017
Last updated
08/30/2017
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