Desert Life Primary Care LLC

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

Legal business name

DESERT LIFE PRIMARY CARE LLC

Practice address

3035 S Ellsworth Rd Ste 121
Mesa, AZ 85212-2137

Phone

(480) 280-7229

NPI assigned

Jul 26, 2021

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

John Woodham

Title

Owner

Phone

(760) 464-4944

Specialties & licenses 3

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Shirene Woodham, DNP FNP-BC AGACNP-BC

  • Family Nurse Practitioner
  • Mesa, AZ
  • NPI 1326527508
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1627257600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1637107200000",
    "number": "1649943655",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3035 S ELLSWORTH RD STE 121",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852122137"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3035 S ELLSWORTH RD STE 121",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852122137",
            "telephone_number": "480-280-7229"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DESERT LIFE PRIMARY CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-07-26",
        "last_updated": "2021-11-17",
        "certification_date": "2021-11-17",
        "status": "A",
        "authorized_official_last_name": "WOODHAM",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "760-464-4944"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Desert Hearing Care
• Desert Highland Family Medical PLLC (Marchand OBGYN)
• Desert House Assisted Living LLC
• Desert Internists PLLC
• Desert Kidney Associates PLC
• Desert Lotus Health and Wellness, LLC
• Desert Mobile Imaging LLC
• Desert Neurosurgery, PC
• Desert Oncology Associates LLP
• Desert Oncology PC

• Nurse Practitioner in Mesa, AZ
• Providers in Mesa, AZ by specialty
• Nurse Practitioner in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.