Individual
IRINA KHAKHANOV
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5777 E MAYO BLVD, PHOENIX, AZ 85054-4502
(646) 249-5910
Mailing address
15437 N 13TH AVE, PHOENIX, AZ 85023-4484
(646) 249-5910
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
F11210467
AZ
Other
Enumeration date
12/22/2021
Last updated
12/22/2021
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