Healthcare Provider Details

I. General information

NPI: 1003611690
Provider Name (Legal Business Name): JULIE PETERS WOUND PRACTITIONER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2025
Last Update Date: 02/17/2025
Certification Date: 02/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 N SOHO PL
CHANDLER AZ
85225-5721
US

IV. Provider business mailing address

1525 S HIGLEY RD STE 104 PMB 2556
GILBERT AZ
85296
US

V. Phone/Fax

Practice location:
  • Phone: 480-223-3061
  • Fax:
Mailing address:
  • Phone: 480-734-8261
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JULIE MARIE PETERS
Title or Position: MEMBER
Credential: FNP-BC
Phone: 480-734-8261