Healthcare Provider Details

I. General information

NPI: 1821557638
Provider Name (Legal Business Name): NOURISH HEALTH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2019
Last Update Date: 03/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31316 N 1ST ST
PHOENIX AZ
85085-7220
US

IV. Provider business mailing address

31316 N 1ST ST
PHOENIX AZ
85085-7220
US

V. Phone/Fax

Practice location:
  • Phone: 602-509-2432
  • Fax:
Mailing address:
  • Phone: 602-509-2432
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QI0500X
TaxonomyInfusion Therapy Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TASHA WOOD
Title or Position: OWNER/NURSE PRACTITIONER
Credential: NP
Phone: 602-509-2432