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General NPI Number Information
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NPI Number | 1114690401
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Entity Type | Organization
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Legal Business Name | LIGHT AT THE END PLLC
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Dates
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Enumeration Date | 08/01/2021
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Last Update Date | 01/02/2026
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Provider Practice Location Address
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Address Line | 21168 E OCOTILLO RD # 1045
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City | QUEEN CREEK
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State | AZ
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Zip | 85142-8175
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Country | US
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Telephone | 623-265-6220
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Fax | 866-491-7389
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Provider Business Mailing Address
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Address Line | 21168 E OCOTILLO RD # 1045
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City | QUEEN CREEK
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State | AZ
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Zip | 85142-8175
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Country | US
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Telephone | 623-265-6220
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Fax | 866-491-7389
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Authorized Official
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Title or Position | CEO
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Name | SHAVAUN J JOHNSON
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Credential | DNP
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Telephone | 623-265-6220
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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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