Individual
SAGE ILAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
5355 E HIGH ST UNIT 101, PHOENIX, AZ 85054-5481
(928) 978-0198
Mailing address
5223 E HERRERA DR, PHOENIX, AZ 85054-7183
(928) 978-0198
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
315482
AZ
Other
Enumeration date
10/10/2024
Last updated
10/12/2024
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