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General NPI Number Information
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NPI Number | 1700606563
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Entity Type | Organization
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Legal Business Name | MAGNOLIA HEALTH & WELLNESS
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Dates
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Enumeration Date | 10/15/2024
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Last Update Date | 10/15/2024
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Provider Practice Location Address
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Address Line | 11052 E SERAFINA AVE
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City | MESA
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State | AZ
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Zip | 85212-5193
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Country | US
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Telephone | 602-345-1192
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Fax |
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Provider Business Mailing Address
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Address Line | 11052 E SERAFINA AVE
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City | MESA
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State | AZ
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Zip | 85212-5193
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Country | US
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Telephone | 480-440-1131
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Fax |
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Authorized Official
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Title or Position | NURSE PRACTITIONER/OWNER
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Name | NICOLE STRUTZENBERG
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Credential | FNP-C
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Telephone | 480-440-1131
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QA0505X
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Taxonomy Name | Adult Medicine Physician
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License Number |
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License Number State |
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