Healthcare Provider Details

I. General information

NPI: 1487517736
Provider Name (Legal Business Name): A1 INTEGRATIVE HEALTH AND WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2025
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1825 E NORTHERN AVE STE 100
PHOENIX AZ
85020-3953
US

IV. Provider business mailing address

1825 E NORTHERN AVE STE 100
PHOENIX AZ
85020-3953
US

V. Phone/Fax

Practice location:
  • Phone: 602-214-9950
  • Fax: 480-956-0844
Mailing address:
  • Phone: 602-214-9950
  • Fax: 480-956-0844

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 6
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: NATHIAN MYERS
Title or Position: OWNER
Credential:
Phone: 480-881-5036