Healthcare Provider Details

I. General information

NPI: 1770074635
Provider Name (Legal Business Name): NP PROFESSIONAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2018
Last Update Date: 08/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3329 E BELL RD STE A1
PHOENIX AZ
85032
US

IV. Provider business mailing address

3329 E BELL RD STE A1
PHOENIX AZ
85032-2756
US

V. Phone/Fax

Practice location:
  • Phone: 602-482-2282
  • Fax: 602-482-2909
Mailing address:
  • Phone: 602-482-2282
  • Fax: 602-482-2909

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ERIN WAYCHOFF
Title or Position: SOLE MBR
Credential: DC
Phone: 602-482-2282