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General NPI Number Information
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NPI Number | 1811603202
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Entity Type | Organization
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Legal Business Name | HEALTHFUL HEALTHCARE PLLC
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Dates
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Enumeration Date | 01/30/2023
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Last Update Date | 10/10/2023
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Provider Practice Location Address
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Address Line | 14961 W BELL RD STE 100
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City | SURPRISE
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State | AZ
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Zip | 85374-3203
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Country | US
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Telephone | 623-439-5176
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Fax | 855-583-1420
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Provider Business Mailing Address
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Address Line | 14961 W BELL RD STE 100
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City | SURPRISE
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State | AZ
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Zip | 85374-3203
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Country | US
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Telephone | 623-606-5524
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Fax |
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Authorized Official
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Title or Position | OWNER/ NURSE PRACTITIONER
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Name | STEPHANIE BLACKMORE
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Credential | APRN
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Telephone | 623-439-5176
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number |
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License Number State |
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