Healthcare Provider Details

I. General information

NPI: 1841918729
Provider Name (Legal Business Name): MVP PROVIDERS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2022
Last Update Date: 08/17/2022
Certification Date: 08/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1530 E WILLIAMS FIELD RD STE 201
GILBERT AZ
85295-1825
US

IV. Provider business mailing address

1530 E WILLIAMS FIELD RD STE 201
GILBERT AZ
85295-1825
US

V. Phone/Fax

Practice location:
  • Phone: 520-510-5825
  • Fax:
Mailing address:
  • Phone: 520-510-5825
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: HAMDA AWAAL
Title or Position: OWNER
Credential:
Phone: 520-510-5825