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Provider Information for 1245619840

Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know


Gender: FEMALE

Individual NPI: 1245619840

Calendar   Last Updated:  2021-04-21
  Certification Date:  2021-04-21


Name Value
NPI 1245619840
Enumeration Date 2015-05-28
NPI Type 1 - Individual
Sole Proprietor YES
Status Active
Mailing Address PO BOX 11616
GLENDALE, AZ 85318-1616
United States

Phone: 480-562-6600 | Fax: 480-562-6606
View Map External Link
Primary Practice Address 8585 E HARTFORD DR STE 103
SCOTTSDALE, AZ 85255-5472
United States

Phone: 480-526-6600 | Fax: 480-562-6606
View Map External Link
Secondary Practice Address 2650 SUZANNE WAY SUITE 200
EUGENE, OR 97408-7319
United States

Phone: 541-228-3100 | Fax:
View Map External Link

Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
Primary Taxonomy Selected Taxonomy State License Number
Yes 363A00000X - Physician Assistant OR PA170134