Individual
MATTHEW DEISE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3033 N CENTRAL AVE STE 700, PHOENIX, AZ 85012-2806
(602) 230-7373
Mailing address
5550 N 16TH ST APT 175, PHOENIX, AZ 85016-2946
(602) 430-3441
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
236093
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000253
—
AZ
Enumeration date
01/06/2020
Last updated
11/18/2021
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