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General NPI Number Information
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NPI Number | 1134816853
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Entity Type | Organization
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Legal Business Name | CONSTITUTIONAL HEALTH LLC
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Dates
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Enumeration Date | 04/21/2023
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Last Update Date | 04/21/2023
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Provider Practice Location Address
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Address Line | 875 N GREENFIELD RD STE 111
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City | GILBERT
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State | AZ
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Zip | 85234-5044
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Country | US
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Telephone | 480-628-3760
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Fax |
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Provider Business Mailing Address
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Address Line | 18829 E INDIANA AVE
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City | QUEEN CREEK
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State | AZ
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Zip | 85142-4554
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Country | US
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Telephone | 480-628-3760
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Fax |
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Authorized Official
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Title or Position | FNP-C
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Name | AMANDA KEIL
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Credential |
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Telephone | 480-628-3760
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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