Healthcare Provider Details

I. General information

NPI: 1588484869
Provider Name (Legal Business Name): FLORENCE WAIRIMU DEUEL PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/12/2024
Last Update Date: 10/12/2024
Certification Date: 10/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41776 W LARAMIE RD
MARICOPA AZ
85138-4462
US

IV. Provider business mailing address

41776 W LARAMIE RD
MARICOPA AZ
85138-4462
US

V. Phone/Fax

Practice location:
  • Phone: 515-505-9680
  • Fax:
Mailing address:
  • Phone: 515-505-9680
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License Number233824
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number233824
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number233824
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: