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General NPI Number Information
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NPI Number | 1477920064
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Entity Type | Organization
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Legal Business Name | VALLEY INTEGRATED WELLNESS LLC
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Dates
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Enumeration Date | 08/31/2015
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Last Update Date | 10/12/2015
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Provider Practice Location Address
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Address Line | 21585 N. 77TH AVENUE SUITE 1500
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City | PEORIA
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State | AZ
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Zip | 85382
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Country | US
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Telephone | 623-476-5227
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Fax | 623-476-8379
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Provider Business Mailing Address
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Address Line | 21585 N. 77TH AVENUE SUITE 1500
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City | PEORIA
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State | AZ
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Zip | 85382
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Country | US
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Telephone | 623-476-5227
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Fax | 623-476-8379
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Authorized Official
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Title or Position | OWNER
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Name | SANDRA L. DECARLO
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Credential | DNP,FNP-C
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Telephone | 623-476-5227
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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