Basic Information
| Provider Information | |||||||||
| NPI: | 1073569083 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DEMASTERS | ||||||||
| FirstName: | LYNN | ||||||||
| MiddleName: | ADAIR | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | PA | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | LUNDQUIST | ||||||||
| OtherFirstName: | LYNN | ||||||||
| OtherMiddleName: | ADAIR | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | PA | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 20201 N SCOTTSDALE HEALTHCARE DR | ||||||||
| Address2: | STE 280 | ||||||||
| City: | SCOTTSDALE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852554134 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4802726344 | ||||||||
| FaxNumber: | 4803079327 | ||||||||
| Practice Location | |||||||||
| Address1: | 20201 N SCOTTSDALE HEALTHCARE DR | ||||||||
| Address2: | STE 280 | ||||||||
| City: | SCOTTSDALE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852554134 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4802726344 | ||||||||
| FaxNumber: | 4803079327 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/25/2006 | ||||||||
| LastUpdateDate: | 04/16/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | PA333 | ID | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363A00000X | 3780 | AZ | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | 633029 | 05 | AZ | MEDICAID |