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1910 S Stapley Dr Ste 120 Mesa AZ 85204-6676 | |
| (800) 922-1873 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 1910 S Stapley Dr Ste 120, Mesa, Arizona |
| Authorized Official Name and Position | Nellie Idara Samuel (CO-OWNER) |
| Authorized Official Contact | 8009221873 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
1910 S Stapley Dr Ste 120 Mesa AZ 85204-6676 Ph: (800) 922-1873 | 1910 S Stapley Dr Ste 120 Mesa AZ 85204-6676 Ph: (800) 922-1873 |
| NPI Number | 1497421101 |
|---|---|
| Provider Enumeration Date | 08/22/2021 |
| Last Update Date | 07/19/2024 |
| Certification Date | 07/16/2024 |
| Medicare PECOS PAC ID | 6406395185 |
|---|---|
| Medicare Enrollment ID | O20240826002904 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1497421101 | NPI | - | NPPES |
| Provider Name | Nellie Idara Samuel |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1821344557 PECOS PAC ID: 1759642044 Enrollment ID: I20180301000886 |
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