Individual
MERITA PAGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
5343 N. 16TH ST. SUITE 270, PHOENIX, AZ 85016
(480) 456-4400
Mailing address
5343 N. 16TH ST. SUITE 270, PHOENIX, AZ 85016
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
PN0002095075
VA
Other
Enumeration date
08/04/2025
Last updated
08/04/2025
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