WELLNESS FOR LIFE FAMILY PRACTICE (NPI# 1083263503) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1083263503 |
| Entity Type | Organization |
| Organization Name | WELLNESS FOR LIFE FAMILY PRACTICE |
| Practice Address |
20449 N Lake Pleasant Rd Ste 101 Peoria AZ 85382-2707 |
| Practice Telephone | 6233220099 |
| Practice Fax Number | 8662285038 |
| Mailing Telephone | 6233220099 |
| Mailing Fax Number | 8662285038 |
| Enumeration Date | 2019-09-06 |
| Last Update Date | 2020-09-25 |
| Authorized Official Name | TONIA LANETTE GRAHAM (OWNER/NURSE PRACTITIONER) |
| Authorized Official Telephone | 6233220099 |
| Authorized Official Credential | FNP-BC |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LP2300X |
Nurse Practitioner Specialization: Primary Care |
Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
20449 N LAKE PLEASANT RD STE 101 |
| City | PEORIA |
| State | AZ |
| Zip Code | 85382-2707 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699108621 | Tonia Lanette Graham | Registered Nurse | 20449 N Lake Pleasant Rd Ste 101, Peoria, AZ 85382 | 2013-08-13 |
| 1639644909 | Black Diamond Medical LLC | Family Medicine | 20449 N Lake Pleasant Rd Ste 101, Peoria, AZ 85382-2707 | 2018-10-12 |
| 1063914398 | Kristin Leigh Serrato | Nurse Practitioner | 20449 N Lake Pleasant Rd Ste 101, Peoria, AZ 85382-2707 | 2018-03-02 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205435146 | Arizona Ot Solutions LLC | Occupational Therapist | 7450 W. Karen Lee Lane, Peoria, AZ 85382 | 2020-10-21 |
| 1497380604 | Idream Psychiatry | Psychiatry & Neurology | 8194 West Deer Valley Rd, 106-516, Peoria, AZ 85382 | 2020-03-08 |
| 1770137648 | Stefan Cseh | Occupational Therapy Assistant | 8765 W Keiton Lane #116, Peona, AZ 85382 | 2019-07-30 |
| 1174177422 | Assyrian Cultural Foundation of Arizona | Homemaker | 9163 West Union Hills Drive, Suite 114 and 115, Peoria, AZ 85382 | 2019-07-25 |
| 1073072765 | Darby Shipman | Physical Therapist | 8685 W. Union Hills Drive, Peoria, AZ 85382 | 2019-03-13 |
| 1811483480 | Kimberly Ann Cochran | Nurse Practitioner | 8194 W Deer Valley Rd Ste 106-516, Peoria, AZ 85382 | 2018-07-07 |
| 1831693514 | Summa Health Care, PC | Family Medicine | 8877 W Union Hills Dr Ste 240, Peoria, AZ 85382 | 2018-03-19 |
| 1497258727 | Nkemdirim Obiora | Nurse Practitioner | 7853 West Lone Cactus Drive, Peoria, AZ 85382 | 2018-03-13 |
| 1851893721 | Alyssa Michelle Bauman | Registered Nurse | 20283 N Lake Pleasant Rd Ste 112, Peoria, AZ 85382 | 2018-03-06 |
| 1043767106 | Jason Mcaddley | Pharmacist | 9425 West Union Hills Drive, Peoria, AZ 85382 | 2016-09-07 |
| Find all providers in zip 85382 | ||||
| Taxonomy Code | 363LP2300X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Primary Care |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538787072 | Brijeshaben Urvish Patel | Nurse Practitioner | 13300 N 88th Ave Apt 2007, Peoria, AZ 85381-2614 | 2020-07-10 |
| 1457906380 | Dana Putman | Nurse Practitioner | 26105 N 137th Ln, Peoria, AZ 85383-8080 | 2019-08-07 |
| 1255815858 | Karibu Family Care Pllc | Nurse Practitioner | 20542 N Lake Pleasant Rd Ste 105, Peoria, AZ 85382-9749 | 2018-09-19 |
| 1003170440 | Diana Sun Bone | Nurse Practitioner | 9947 West Happy Valley Parkway, # 104, Peoria, AZ 85383-6001 | 2012-06-29 |
| 1851333819 | Tina White | Nurse Practitioner | 1419 S Folkers Ave, Peoria, IL 61605-1356 | 2006-06-12 |
| 1457398265 | Cheryl Kliot-lape | Nurse Practitioner | 800 W Romeo B Garrett Ave, Peoria, IL 61605-2207 | 2006-06-01 |
| 1366913618 | Krishna Keshav | Nurse Practitioner | 13640 N Plaza Del Rio Blvd, Peoria, AZ 85381 | 2018-12-16 |
| 1407223969 | Teresa Michelle Watts | Nurse Practitioner | 900 Main St, Suite 100, Peoria, IL 61602-1005 | 2015-08-31 |
| 1881912392 | Jailson Souza Nascimento | Nurse Practitioner | 530 Ne Glen Oak Ave, Peoria, IL 61637-0001 | 2010-05-07 |
| 1164561130 | Amy Marie Davis | Nurse Practitioner | 5401 N Knoxville Ave Ste 207, Peoria, IL 61614-5021 | 2007-02-06 |
| Find all providers in PEORIA | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.