Healthcare Provider Details

I. General information

NPI: 1992476543
Provider Name (Legal Business Name): YOUR HEALTH AND WELLNESS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2021
Last Update Date: 12/20/2023
Certification Date: 12/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3326 N 3RD AVE STE 201
PHOENIX AZ
85013-4336
US

IV. Provider business mailing address

3326 N 3RD AVE STE 201
PHOENIX AZ
85013-4336
US

V. Phone/Fax

Practice location:
  • Phone: 602-625-7944
  • Fax:
Mailing address:
  • Phone: 602-625-7944
  • Fax: 602-865-7576

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MARK KNOBLAUCH
Title or Position: OWNER
Credential: FNP-BC
Phone: 602-625-7944