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General NPI Number Information
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NPI Number | 1760760250
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Entity Type | Organization
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Legal Business Name | NEW DIRECTIONS INTEGRATIVE WELLNESS CENTER OF WICKENBURG, ARIZONA, PLL
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Dates
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Enumeration Date | 08/01/2011
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Last Update Date | 08/01/2011
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Provider Practice Location Address
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Address Line | 370 PALM DRIVE
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City | WICKENBURG
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State | AZ
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Zip | 85390
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Country | US
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Telephone | 928-220-8216
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Fax | 716-408-1100
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Provider Business Mailing Address
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Address Line | 370 PALM DRIVE
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City | WICKENBURG
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State | AZ
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Zip | 85390
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Country | US
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Telephone | 928-220-8216
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Fax | 716-408-1100
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Authorized Official
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Title or Position | CHIEF OFFICE ADMINISTRATOR
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Name | MRS. AMANDA RAE COBURN
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Credential | MSED
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Telephone | 716-307-5969
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | AP4081
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License Number State | AZ
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