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General NPI Number Information
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NPI Number | 1801658117
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Entity Type | Organization
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Legal Business Name | AGAPE FAMILY WELLNESS
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Dates
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Enumeration Date | 01/23/2024
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Last Update Date | 01/18/2025
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Provider Practice Location Address
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Address Line | 640 W MARYLAND AVE STE 4
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City | PHOENIX
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State | AZ
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Zip | 85013-1398
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Country | US
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Telephone | 602-795-8122
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Fax | 833-973-0963
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Provider Business Mailing Address
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Address Line | 640 W MARYLAND AVE STE 4
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City | PHOENIX
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State | AZ
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Zip | 85013-1398
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Country | US
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Telephone | 602-795-8122
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Fax | 833-973-0963
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Authorized Official
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Title or Position | FNP
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Name | RONDA SLICKMAN
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Credential | DNP
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Telephone | 602-770-8571
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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