Individual
JISMI THEEYATTUVELI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
51 S 48TH ST, MESA, AZ 85206-1250
(480) 832-8333
Mailing address
4291 E LEXINGTON AVE, GILBERT, AZ 85234-0729
(480) 310-8524
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
138064
AZ
363L00000X
Nurse Practitioner
Primary
254316
AZ
Other
Enumeration date
03/08/2021
Last updated
11/14/2022
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