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General NPI Number Information
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NPI Number | 1770264715
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Entity Type | Organization
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Legal Business Name | WASHINGTON WELLNESS MOBILE
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Dates
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Enumeration Date | 07/31/2023
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Last Update Date | 11/03/2023
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Provider Practice Location Address
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Address Line | 2730 W AGUA FRIA FWY STE 104
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City | PHOENIX
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State | AZ
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Zip | 85027-7202
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Country | US
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Telephone | 623-434-6694
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Fax |
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Provider Business Mailing Address
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Address Line | 2730 W AGUA FRIA FWY STE 104
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City | PHOENIX
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State | AZ
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Zip | 85027-7202
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Country | US
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Telephone | 623-434-6698
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Fax | 623-434-6694
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Authorized Official
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Title or Position | OWNER/CEO / PROVIDER
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Name | CARMEN R WASHINGTON
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Credential | EDD. FNP
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Telephone | 623-434-6698
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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 |
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License Number State |
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