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General NPI Number Information
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NPI Number | 1952087637
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Entity Type | Organization
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Legal Business Name | MAPO WELLNESS CENTER LLC
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Dates
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Enumeration Date | 06/26/2023
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Last Update Date | 06/26/2023
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Provider Practice Location Address
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Address Line | 4494 W PEORIA AVE STE 13-115A
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City | GLENDALE
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State | AZ
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Zip | 85302-2023
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Country | US
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Telephone | 901-800-1037
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Fax |
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Provider Business Mailing Address
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Address Line | 8225 ROCKCREEK PKWY
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City | CORDOVA
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State | TN
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Zip | 38016-4594
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Country | US
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Telephone | 901-800-1037
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | HORTENSE BISSILA
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Credential | PMHNP
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Telephone | 901-800-1037
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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