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General NPI Number Information
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NPI Number | 1154941763
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Entity Type | Organization
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Legal Business Name | QUEEN CREEK NATUROPATHIC PLLC
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Dates
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Enumeration Date | 04/23/2020
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Last Update Date | 04/23/2020
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Provider Practice Location Address
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Address Line | 21820 S ELLSWORTH RD # 101
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City | QUEEN CREEK
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State | AZ
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Zip | 85142-9485
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Country | US
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Telephone | 480-296-6173
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Fax | 480-677-8310
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Provider Business Mailing Address
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Address Line | 21820 S ELLSWORTH RD STE 101
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City | QUEEN CREEK
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State | AZ
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Zip | 85142-6177
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Country | US
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Telephone | 480-296-6173
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Fax | 480-677-8310
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Authorized Official
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Title or Position | PHYSICAN
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Name | KRISTIN BERKNER
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Credential | ND
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Telephone | 480-250-1924
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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