Provider Demographics
NPI:1043595424
Name:INNATE HEALTH AND WELLNESS FAMILY PRACTICE, LLC
Entity Type:Organization
Organization Name:INNATE HEALTH AND WELLNESS FAMILY PRACTICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:HELEN
Authorized Official - Middle Name:
Authorized Official - Last Name:COBB
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-BC
Authorized Official - Phone:602-769-1248
Mailing Address - Street 1:7841 N CITRUS RD
Mailing Address - Street 2:
Mailing Address - City:WADDELL
Mailing Address - State:AZ
Mailing Address - Zip Code:85355-9370
Mailing Address - Country:US
Mailing Address - Phone:602-769-1248
Mailing Address - Fax:
Practice Address - Street 1:7841 N CITRUS RD
Practice Address - Street 2:
Practice Address - City:WADDELL
Practice Address - State:AZ
Practice Address - Zip Code:85355-9370
Practice Address - Country:US
Practice Address - Phone:602-769-1248
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-17
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP2593363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1366561086OtherFAMILY NURSE PRACTITIONER