Healthcare Provider Details

I. General information

NPI: 1477921385
Provider Name (Legal Business Name): WESTWIND MANAGEMENT INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2015
Last Update Date: 04/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3019 N 35TH AVE
PHOENIX AZ
85017-5206
US

IV. Provider business mailing address

3019 N 35TH AVE
PHOENIX AZ
85017-5206
US

V. Phone/Fax

Practice location:
  • Phone: 602-269-7797
  • Fax: 602-269-2329
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: KRISTOPHER KNIGHT
Title or Position: REGIONAL MANAGER
Credential:
Phone: 602-269-7797