Healthcare Provider Details

I. General information

NPI: 1801516687
Provider Name (Legal Business Name): DIVINE GRACE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2022
Last Update Date: 12/04/2024
Certification Date: 12/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6751 N SUNSET BLVD STE 320
GLENDALE AZ
85305-3155
US

IV. Provider business mailing address

6751 N SUNSET BLVD STE 320
GLENDALE AZ
85305-3155
US

V. Phone/Fax

Practice location:
  • Phone: 602-621-7561
  • Fax: 602-837-5300
Mailing address:
  • Phone: 602-621-7561
  • Fax: 602-837-5300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: SHARON UCHECHI JOSHUA
Title or Position: NP-BC
Credential: FNP-C, PMHNP-BC
Phone: 602-621-7561