Healthcare Provider Details

I. General information

NPI: 1134816853
Provider Name (Legal Business Name): CONSTITUTIONAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2023
Last Update Date: 04/21/2023
Certification Date: 04/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

875 N GREENFIELD RD STE 111
GILBERT AZ
85234-5044
US

IV. Provider business mailing address

18829 E INDIANA AVE
QUEEN CREEK AZ
85142-4554
US

V. Phone/Fax

Practice location:
  • Phone: 480-628-3760
  • Fax:
Mailing address:
  • Phone: 480-628-3760
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: AMANDA KEIL
Title or Position: FNP-C
Credential:
Phone: 480-628-3760