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General NPI Number Information
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NPI Number | 1386210508
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Entity Type | Organization
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Legal Business Name | AGAVE POSTPARTUM WELLNESS CLINIC PLLC
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Dates
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Enumeration Date | 05/28/2021
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Last Update Date | 05/04/2022
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Provider Practice Location Address
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Address Line | 21725 N 20TH AVE SUITE 101-102 #1019
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City | PHOENIX
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State | AZ
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Zip | 85027-2640
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Country | US
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Telephone | 602-384-1648
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Fax |
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Provider Business Mailing Address
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Address Line | 21725 N 20TH AVE SUITE 101-102 #1019
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City | PHOENIX
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State | AZ
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Zip | 85027-2640
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Country | US
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Telephone | 602-384-1648
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Fax |
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Authorized Official
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Title or Position | OWNER/PROVIDER
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Name | INTY ALLEN
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Credential | FNP
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Telephone | 602-384-1648
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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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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