Provider Demographics
NPI:1134687486
Name:L.I.G. INVESTMENT GROUP, LLC
Entity type:Organization
Organization Name:L.I.G. INVESTMENT GROUP, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FAMILY NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:TANGECA
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:WELLS
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:602-885-0329
Mailing Address - Street 1:20987 N JOHN WAYNE PKWY STE B104-415
Mailing Address - Street 2:
Mailing Address - City:MARICOPA
Mailing Address - State:AZ
Mailing Address - Zip Code:85139-2926
Mailing Address - Country:US
Mailing Address - Phone:602-885-0329
Mailing Address - Fax:
Practice Address - Street 1:19756 N JOHN WAYNE PKWY
Practice Address - Street 2:SUITE 111
Practice Address - City:MARICOPA
Practice Address - State:AZ
Practice Address - Zip Code:85139
Practice Address - Country:US
Practice Address - Phone:602-885-0329
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-06
Last Update Date:2019-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care