Healthcare Provider Details

I. General information

NPI: 1407087604
Provider Name (Legal Business Name): MS. YEVGENIA MEHER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2009
Last Update Date: 08/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7027 N 11TH ST
PHOENIX AZ
85020-5308
US

IV. Provider business mailing address

7027 N 11TH ST
PHOENIX AZ
85020-5308
US

V. Phone/Fax

Practice location:
  • Phone: 602-296-7193
  • Fax: 602-296-7193
Mailing address:
  • Phone: 602-296-7193
  • Fax: 602-296-7193

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License NumberL15351064
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: