Provider Demographics
NPI:1538306360
Name:WHOLISTIC INTEGRATIVE CARING NETWORK LLC
Entity Type:Organization
Organization Name:WHOLISTIC INTEGRATIVE CARING NETWORK LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:LORETTA
Authorized Official - Middle Name:J
Authorized Official - Last Name:AMITRANO
Authorized Official - Suffix:
Authorized Official - Credentials:MSN/FNP
Authorized Official - Phone:602-290-3767
Mailing Address - Street 1:16278 N. 164TH LANE
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85388
Mailing Address - Country:US
Mailing Address - Phone:623-322-0457
Mailing Address - Fax:623-322-0457
Practice Address - Street 1:16278 N. 164TH LANE
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85388
Practice Address - Country:US
Practice Address - Phone:623-322-0457
Practice Address - Fax:623-322-0457
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-15
Last Update Date:2009-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP2854363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty