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General NPI Number Information
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NPI Number | 1346899440
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Entity Type | Organization
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Legal Business Name | KARL WICK PMHNP-BC LLC
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Dates
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Enumeration Date | 09/10/2019
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Last Update Date | 09/10/2019
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Provider Practice Location Address
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Address Line | 618 S MADISON DR
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City | TEMPE
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State | AZ
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Zip | 85281-7248
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Country | US
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Telephone | 602-633-5563
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Fax |
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Provider Business Mailing Address
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Address Line | 9562 WILDWOOD DR
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City | CHARDON
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State | OH
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Zip | 44024-9134
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Country | US
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Telephone | 602-633-5563
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Fax |
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Authorized Official
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Title or Position | OWNER MANAGER
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Name | MR. KARL B WICK
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Credential | PMHNP-BC
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Telephone | 602-633-5563
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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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