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General NPI Number Information
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NPI Number | 1992476543
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Entity Type | Organization
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Legal Business Name | YOUR HEALTH AND WELLNESS PLLC
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Dates
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Enumeration Date | 09/23/2021
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Last Update Date | 12/20/2023
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Provider Practice Location Address
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Address Line | 3326 N 3RD AVE STE 201
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City | PHOENIX
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State | AZ
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Zip | 85013-4336
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Country | US
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Telephone | 602-625-7944
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Fax |
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Provider Business Mailing Address
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Address Line | 3326 N 3RD AVE STE 201
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City | PHOENIX
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State | AZ
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Zip | 85013-4336
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Country | US
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Telephone | 602-625-7944
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Fax | 602-865-7576
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Authorized Official
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Title or Position | OWNER
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Name | MARK KNOBLAUCH
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Credential | FNP-BC
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Telephone | 602-625-7944
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health 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 | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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