Provider Demographics
NPI:1265733018
Name:IMMUNE RECOVERY AND WELLNESS PC
Entity type:Organization
Organization Name:IMMUNE RECOVERY AND WELLNESS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RECEPTIONIST
Authorized Official - Prefix:
Authorized Official - First Name:KATHI
Authorized Official - Middle Name:
Authorized Official - Last Name:ALVARADO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-751-0100
Mailing Address - Street 1:2122 N CRAYCROFT RD
Mailing Address - Street 2:SUITE 112
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-2849
Mailing Address - Country:US
Mailing Address - Phone:520-751-0100
Mailing Address - Fax:520-751-0101
Practice Address - Street 1:2122 N CRAYCROFT RD
Practice Address - Street 2:SUITE 112
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-2849
Practice Address - Country:US
Practice Address - Phone:520-751-0100
Practice Address - Fax:520-751-0101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-10
Last Update Date:2011-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN036763363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty