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General NPI Number Information
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NPI Number | 1750279048
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Entity Type | Organization
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Legal Business Name | HUMMINGBIRD HOPE
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Dates
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Enumeration Date | 06/25/2025
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Last Update Date | 08/03/2025
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Provider Practice Location Address
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Address Line | 1737 E BROADWAY RD STE 104
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City | TEMPE
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State | AZ
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Zip | 85282-2080
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Country | US
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Telephone | 480-915-2931
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Fax |
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Provider Business Mailing Address
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Address Line | 13611 W HOLLY ST
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City | GOODYEAR
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State | AZ
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Zip | 85395-2407
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Country | US
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Telephone | 480-332-3561
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Fax |
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Authorized Official
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Title or Position | PROVIDER / OFFICER
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Name | NICOLE LARSEN
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Credential | NP
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Telephone | 480-915-2931
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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