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General NPI Number Information
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NPI Number | 1972879732
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Entity Type | Individual
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Provider Name | DOMTILA J MWEI NP
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Gender | Female
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Dates
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Enumeration Date | 03/27/2012
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Last Update Date | 06/13/2025
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Provider Practice Location Address
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Address Line | 2375 E CAMELBACK RD STE 600
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City | PHOENIX
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State | AZ
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Zip | 85016-3493
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Country | US
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Telephone | 602-551-8052
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Fax | 602-428-7025
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Provider Business Mailing Address
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Address Line | 24 FRANK LLOYD WRIGHT DR PO BOX 0446 - LOBBY J
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City | ANN ARBOR
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State | MI
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Zip | 48105-9484
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Country | US
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Telephone | 734-747-6766
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 4704254216
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License Number State | MI
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