Provider Demographics
NPI:1750279048
Name:HUMMINGBIRD HOPE
Entity type:Organization
Organization Name:HUMMINGBIRD HOPE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER / OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:LARSEN
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:480-915-2931
Mailing Address - Street 1:13611 W HOLLY ST
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85395-2407
Mailing Address - Country:US
Mailing Address - Phone:480-332-3561
Mailing Address - Fax:
Practice Address - Street 1:1737 E BROADWAY RD STE 104
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-2080
Practice Address - Country:US
Practice Address - Phone:480-915-2931
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-25
Last Update Date:2025-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty