Healthcare Provider Details

I. General information

NPI: 1790648327
Provider Name (Legal Business Name): HG MAMA COACH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2025
Last Update Date: 12/09/2025
Certification Date: 11/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4512 W PEARCE RD
LAVEEN AZ
85339
US

IV. Provider business mailing address

4611 E CHANDLER BLVD STE 112
PHOENIX AZ
85048-0442
US

V. Phone/Fax

Practice location:
  • Phone: 602-499-3866
  • Fax:
Mailing address:
  • Phone: 602-499-3866
  • 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: HANNAH GAMMAGE
Title or Position: OWNER
Credential: NP
Phone: 775-530-5225