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General NPI Number Information
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NPI Number | 1346301629
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Entity Type | Organization
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Legal Business Name | FOREVER FAMILY HEALTHCARE LLC
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Dates
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Enumeration Date | 12/12/2006
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Last Update Date | 11/30/2022
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Provider Practice Location Address
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Address Line | 12010 S WARNER ELLIOT LOOP STE 1
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City | PHOENIX
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State | AZ
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Zip | 85044-2731
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Country | US
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Telephone | 480-961-2366
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Fax | 480-961-2367
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Provider Business Mailing Address
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Address Line | 12010 S WARNER ELLIOT LOOP STE 1A
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City | PHOENIX
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State | AZ
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Zip | 85044-2731
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Country | US
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Telephone | 480-961-2366
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Fax | 480-961-2367
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | JONNE AMORETTE HOUSH
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Credential | MSN, NP-C
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Telephone | 480-961-2366
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 2959
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License Number State | AZ
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