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General NPI Number Information
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NPI Number | 1922371202
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Entity Type | Organization
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Legal Business Name | INTEGRATIVE & WELLNESS OF ARIZONA PLLC
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Dates
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Enumeration Date | 02/16/2012
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Last Update Date | 06/06/2012
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Provider Practice Location Address
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Address Line | 1110 E ROUTE 66 STE 202
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City | FLAGSTAFF
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State | AZ
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Zip | 86001-4773
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Country | US
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Telephone | 928-214-7400
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Fax | 928-214-7401
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Provider Business Mailing Address
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Address Line | 1110 E ROUTE 66 STE 202
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City | FLAGSTAFF
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State | AZ
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Zip | 86001-4773
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Country | US
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Telephone | 928-214-7400
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Fax | 928-214-7401
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Authorized Official
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Title or Position | OWNER
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Name | VICKI JOYCE
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Credential | NP
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Telephone | 928-214-7400
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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 | RN147575
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License Number State | AZ
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