Healthcare Provider Details

I. General information

NPI: 1962295048
Provider Name (Legal Business Name): ON THE GO NEUROLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2025
Last Update Date: 05/22/2025
Certification Date: 05/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2220 S VALLE VERDE
MESA AZ
85209-1529
US

IV. Provider business mailing address

2220 S VALLE VERDE
MESA AZ
85209-1529
US

V. Phone/Fax

Practice location:
  • Phone: 480-544-3417
  • Fax:
Mailing address:
  • Phone: 480-544-3417
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code163WN0800X
TaxonomyNeuroscience Registered Nurse
License Number
License Number StateNULL

VIII. Authorized Official

Name: JACQUELINE LORRIENE MURPHY
Title or Position: NURSE PRACTITIONER
Credential: DNP, APRN, FNP-BC
Phone: 480-544-3417