Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | AP7776 | AZ |
NPI | 1003293606 |
---|---|
Provider Name | Mark Wesbrock |
First Address | Gilbert, AZ 85295-1675 |
Second Address | Gilbert, AZ 85295-1675 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/05/2015 |
Last Update Date | 03/05/2015 |