Provider Demographics
NPI:1922371202
Name:INTEGRATIVE & WELLNESS OF ARIZONA PLLC
Entity Type:Organization
Organization Name:INTEGRATIVE & WELLNESS OF ARIZONA PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VICKI
Authorized Official - Middle Name:
Authorized Official - Last Name:JOYCE
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:928-214-7400
Mailing Address - Street 1:1110 E ROUTE 66
Mailing Address - Street 2:STE 202
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-4773
Mailing Address - Country:US
Mailing Address - Phone:928-214-7400
Mailing Address - Fax:928-214-7401
Practice Address - Street 1:1110 E ROUTE 66
Practice Address - Street 2:STE 202
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-4773
Practice Address - Country:US
Practice Address - Phone:928-214-7400
Practice Address - Fax:928-214-7401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-16
Last Update Date:2012-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN147575363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ125053Medicare PIN