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Individual

LIA DOH

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
NP

Contact information

Practice address
1111 S STAPLEY DR, MESA, AZ 85204-5059
(602) 302-7900
(480) 834-5703
Mailing address
3003 N CENTRAL AVE STE 400, PHOENIX, AZ 85012-2929
(714) 512-7646

Taxonomy

Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
237646
AZ
363LF0000X
Family Nurse Practitioner
237646
AZ
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
237646
AZ

Other

Enumeration date
02/05/2020
Last updated
11/26/2025
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