Healthcare Provider Details

I. General information

NPI: 1649917535
Provider Name (Legal Business Name): UNCHARTED HEALTHCARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2022
Last Update Date: 04/11/2023
Certification Date: 04/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 S LITCHFIELD RD STE 210-I
GOODYEAR AZ
85338-1513
US

IV. Provider business mailing address

1300 S LITCHFIELD RD STE 210I
GOODYEAR AZ
85338-1583
US

V. Phone/Fax

Practice location:
  • Phone: 623-248-0297
  • Fax: 623-248-0299
Mailing address:
  • Phone: 623-248-0297
  • Fax: 623-248-0299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: SARA INGRAM
Title or Position: FNP
Credential: FNP
Phone: 602-373-0932