Organization
GOLDEN PHOENIX WELLNESS CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STEPHANIE FULLER (CO-CEO)
(214) 405-5556
Entity
Organization
Contact information
Practice address
600 BROADWAY STE 200-4502, ALBANY, NY 12207-2236
(214) 405-5556
Mailing address
600 BROADWAY STE 200-4502, ALBANY, NY 12207-2236
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
363L00000X
Nurse Practitioner
—
—
Other
Enumeration date
12/08/2021
Last updated
01/06/2022
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