Healthcare Provider Details

I. General information

NPI: 1013812106
Provider Name (Legal Business Name): INTEGRATIVE FAMILY AND PSYCHIATRIC CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2026
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4425 W OLIVE AVE
GLENDALE AZ
85302-3843
US

IV. Provider business mailing address

23853 W LA CANADA BLVD
BUCKEYE AZ
85396-6399
US

V. Phone/Fax

Practice location:
  • Phone: 623-329-0551
  • Fax: 725-433-9262
Mailing address:
  • Phone: 623-329-0551
  • Fax: 725-433-9262

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number StateNULL

VIII. Authorized Official

Name: SHANNON RAQUEL MILES
Title or Position: OWNER
Credential: FNP
Phone: 623-329-0551