Healthcare Provider Details

I. General information

NPI: 1538533013
Provider Name (Legal Business Name): I WANT TO BE HEALTHY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2015
Last Update Date: 10/08/2020
Certification Date: 10/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18247 N TOYA ST
MARICOPA AZ
85138-2905
US

IV. Provider business mailing address

18247 N TOYA ST
MARICOPA AZ
85138-2905
US

V. Phone/Fax

Practice location:
  • Phone: 832-964-4022
  • Fax: 347-960-4805
Mailing address:
  • Phone: 832-964-4022
  • Fax: 347-960-4805

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP3446
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP5602
License Number StateAZ
# 4
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: LUCHIA LYNNETTE YOUNG
Title or Position: PROVIDER
Credential:
Phone: 832-964-4022