=====================================================
General NPI Number Information
=====================================================
NPI Number | 1639946593
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SUNSET WEIGHT AND WELLNESS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/11/2023
-----------------------------------------------------
Last Update Date | 12/11/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1846 E INNOVATION PARK DR STE 100
-----------------------------------------------------
City | ORO VALLEY
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85755-1963
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 623-680-6664
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1241
-----------------------------------------------------
City | VAIL
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85641-1241
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 623-680-6664
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | FAMILY NURSE PRACTITIONER
-----------------------------------------------------
Name | LAURIE A. MCMAHON
-----------------------------------------------------
Credential | FNP-C
-----------------------------------------------------
Telephone | 623-680-6664
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------