COUNTRY CLUB MEDICAL WEIGHT LOSS & WELLNESS PLLC
NPI 1205616398
Nurse Practitioner - Family in Mesa, AZ

Q: What is Country Club Medical Weight Loss & Wellness PLLC's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.

Active since October 05, 2023

1855 S COUNTRY CLUB DR STE 111-130, MESA, AZ 85210(480) 840-4777 Get Directions Write a Review

NPPES record last updated: October 5, 2023. Verified against the NPPES registry weekly; last sync: August 16, 2026.

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About Country Club Medical Weight Loss & Wellness Pllc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

COUNTRY CLUB MEDICAL WEIGHT LOSS & WELLNESS PLLC (NPI 1205616398) is a healthcare organization registered as a family in Mesa, Arizona and active in the NPI registry since October 2023. The organization lists Flora Issanda Stowater, Owner/manager, as its authorized official.

NPPES Registry Identity

NPI1205616398

Entity TypeOrganization

Primary Taxonomy363LF0000X

Legal Business NameCOUNTRY CLUB MEDICAL WEIGHT LOSS & WELLNESS PLLC

Location Address1855 S COUNTRY CLUB DR STE 111-130Mesa, AZ 85210-6037

Mailing AddressPo Box 697Laveen, AZ 85339-0697 · (480) 840-4777

Phone(480) 840-4777

Organization SubpartNo

Authorized OfficialFlora Issanda StowaterOwner/manager · (480) 840-4777

Enumeration DateOctober 5, 2023

NPPES CertifiedOctober 5, 2023

✔ NPI 1205616398 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · FamilyPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363LF0000X

1855 S COUNTRY CLUB DR STE 111-130, Mesa, AZ 85210

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Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

FLORA ISSANDA STOWATER NP

Nurse Practitioner

1855 S COUNTRY CLUB DR STE 111-130
MESA, AZ 85210

Maricopa County (480) 840-4777

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Country Club Medical Weight Loss & Wellness PLLC's NPI number?

The NPI number for Country Club Medical Weight Loss & Wellness PLLC is 1205616398. It was assigned to this organization in the NPPES registry on October 5, 2023.

Where is Country Club Medical Weight Loss & Wellness PLLC located?

Country Club Medical Weight Loss & Wellness PLLC is located at 1855 S Country Club Dr Ste 111-130, Mesa, AZ 85210. The listed phone number is (480) 840-4777.

What is Country Club Medical Weight Loss & Wellness PLLC's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.

When was this NPI record last updated?

The NPPES record for Country Club Medical Weight Loss & Wellness PLLC was last updated on October 5, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.