Healthcare Provider Details

I. General information

NPI: 1134687486
Provider Name (Legal Business Name): L.I.G. INVESTMENT GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2019
Last Update Date: 05/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19756 N JOHN WAYNE PKWY SUITE 111
MARICOPA AZ
85139
US

IV. Provider business mailing address

20987 N JOHN WAYNE PKWY STE B104-415
MARICOPA AZ
85139-2926
US

V. Phone/Fax

Practice location:
  • Phone: 602-885-0329
  • Fax:
Mailing address:
  • Phone: 602-885-0329
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QI0500X
TaxonomyInfusion Therapy Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TANGECA ELIZABETH WELLS
Title or Position: FAMILY NURSE PRACTITIONER
Credential: FNP-C
Phone: 602-885-0329