=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962288282
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MOMENTUM HEALTH PLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/01/2023
-----------------------------------------------------
Last Update Date | 01/01/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 985 N ARIZONA BLVD
-----------------------------------------------------
City | COOLIDGE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85128-3726
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 928-216-2991
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7760 E STATE ROUTE 69 STE C5-234
-----------------------------------------------------
City | PRESCOTT VALLEY
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 86314-2201
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 928-216-2991
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MR. NATHANIEL HOLTZMAN
-----------------------------------------------------
Credential | PMHNP
-----------------------------------------------------
Telephone | 928-216-2991
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------