Provider Demographics
NPI:1316569759
Name:PREFERRED BODY SOLUTIONS LLC
Entity Type:Organization
Organization Name:PREFERRED BODY SOLUTIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAMECK
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:NYAKWEBA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-430-9646
Mailing Address - Street 1:11418 W ROSEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:AVONDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85392-3421
Mailing Address - Country:US
Mailing Address - Phone:602-430-9646
Mailing Address - Fax:
Practice Address - Street 1:11418 W ROSEWOOD DR
Practice Address - Street 2:
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85392-3421
Practice Address - Country:US
Practice Address - Phone:602-430-9646
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-07
Last Update Date:2020-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty