Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Country Club Medical Weight Loss & Wellness PLLC

Organization Family Nurse Practitioner · NPI 1205616398

Country Club Medical Weight Loss & Wellness PLLC is a Family Nurse Practitioner in Mesa, Arizona. Registered with an NPI since 2023.

In the registry since
2023
What do these letters mean?
PLLC — Professional limited liability company
A form of business registration, not a clinical qualification.

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Practice location Address checks out

1855 S Country Club Dr Ste 111-130
Mesa, AZ 85210-6037
Phone: (480) 840-4777
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Nurse Practitioner (primary) Taxonomy 363LF0000X

Record details

NPI number1205616398
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Flora Issanda Stowater — Owner/Manager · (480) 840-4777
NPI enumeratedOctober 5, 2023
Last updated in NPPESOctober 5, 2023
Certification dateOctober 5, 2023
Mailing addressPo Box 697, Laveen, AZ 85339-0697

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