MEDICARE: YOUR HEALTH DISTRICT, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner

General Provider Information

NPI Number	:	1174021216
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	YOUR HEALTH DISTRICT, LLC

Provider Business Mailing Address
First Line	:	39506 N DAISY MOUNTAIN DR STE 122169
Second Line	:
City	:	ANTHEM
State	:	AZ
Zip	:	85086-6068
Country	:	US
Telephone Number	:	623-748-9106
Fax Number	:

Provider Business Practice Location Address
First Line	:	2525 W CAREFREE HWY STE 118
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85085-9302
Country	:	US
Telephone Number	:	623-748-9106
Fax Number	:	602-429-8579

Authorized Official
Title or Position	:	CO-OWNER
Name	:	LAURA MAGOFFIE
Credential	:
Telephone Number	:	623-748-9106

Provider Enumeration Date	:	01/23/2018
Last Update Date	:	01/07/2019

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