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General NPI Number Information
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NPI Number | 1114643905
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Entity Type | Organization
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Legal Business Name | DYNASTY OF SELAH INTEGRATED HEALTH SERVICES PLLC
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Dates
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Enumeration Date | 10/13/2022
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Last Update Date | 12/02/2022
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Provider Practice Location Address
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Address Line | 1846 E INNOVATION PARK DR
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City | ORO VALLEY
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State | AZ
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Zip | 85755-1963
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Country | US
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Telephone | 770-231-3593
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Fax |
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Provider Business Mailing Address
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Address Line | 1846 E INNOVATION PARK DR
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City | ORO VALLEY
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State | AZ
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Zip | 85755-1963
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Country | US
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Telephone | 770-231-3593
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Fax |
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Authorized Official
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Title or Position | OWNER OF ENTITY
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Name | TARA C CHERRY
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Credential |
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Telephone | 770-231-3593
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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