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General NPI Number Information
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NPI Number | 1205251543
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Entity Type | Organization
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Legal Business Name | NIOSTAR SERVICES LLC
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Dates
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Enumeration Date | 02/24/2014
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Last Update Date | 02/24/2014
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Provider Practice Location Address
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Address Line | 11974 N 158TH LN
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City | SURPRISE
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State | AZ
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Zip | 85379-1067
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Country | US
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Telephone | 248-890-2078
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Fax |
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Provider Business Mailing Address
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Address Line | 11974 N 158TH LN
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City | SURPRISE
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State | AZ
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Zip | 85379-1067
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Country | US
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Telephone | 248-890-2078
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | CHISOMNAZU WINIFRED IWEHA-ONONYE
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Credential | NP
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Telephone | 248-890-2078
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | AP4314
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License Number State | AZ
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