Healthcare Provider Details

I. General information

NPI: 1720982994
Provider Name (Legal Business Name): THE HEALING MANTLE WOMEN HEALTH CONCIERGE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2026
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4539 N 22ND ST STE B
PHOENIX AZ
85016-4639
US

IV. Provider business mailing address

4539 N 22ND ST STE B
PHOENIX AZ
85016-4639
US

V. Phone/Fax

Practice location:
  • Phone: 623-400-3958
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number
License Number StateNULL

VIII. Authorized Official

Name: RETHA HOWARD
Title or Position: OWNER, CEO
Credential:
Phone: 623-400-3958