Provider Demographics
NPI: | 1366217648 |
---|---|
Name: | NATIONWIDE PSYCHIATRY |
Entity type: | Organization |
Organization Name: | NATIONWIDE PSYCHIATRY |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | CO-OWNER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | GEORGETTE |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | QUIE |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 602-497-1588 |
Mailing Address - Street 1: | 2982 N ALMA SCHOOL RD STE 2 |
Mailing Address - Street 2: | |
Mailing Address - City: | CHANDLER |
Mailing Address - State: | AZ |
Mailing Address - Zip Code: | 85224-6700 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 602-497-1588 |
Mailing Address - Fax: | 602-581-7405 |
Practice Address - Street 1: | 2982 N ALMA SCHOOL RD STE 2 |
Practice Address - Street 2: | |
Practice Address - City: | CHANDLER |
Practice Address - State: | AZ |
Practice Address - Zip Code: | 85224-6700 |
Practice Address - Country: | US |
Practice Address - Phone: | 602-497-1588 |
Practice Address - Fax: | 602-581-7405 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2023-11-16 |
Last Update Date: | 2024-06-26 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 363LP0808X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psychiatric/Mental Health | Group - Multi-Specialty |