Healthcare Provider Details

I. General information

NPI: 1215553425
Provider Name (Legal Business Name): CYPRESS HEALTH AND WELLNESS SPA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2020
Last Update Date: 06/23/2020
Certification Date: 06/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 N GILBERT RD
MESA AZ
85203-6629
US

IV. Provider business mailing address

605 N GILBERT RD
MESA AZ
85203-6629
US

V. Phone/Fax

Practice location:
  • Phone: 775-685-0156
  • Fax:
Mailing address:
  • Phone: 775-685-0156
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DALE HIAPO HENSON
Title or Position: MEMBER
Credential:
Phone: 775-685-0156