Basic Information
| Provider Information | |||||||||
| NPI: | 1285178145 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WESTBROOK | ||||||||
| FirstName: | ABBY | ||||||||
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| Credential: | CSFA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1847 | ||||||||
| Address2: | |||||||||
| City: | GILBERT | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852991847 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4805072961 | ||||||||
| FaxNumber: | 4805072971 | ||||||||
| Practice Location | |||||||||
| Address1: | 428 S GILBERT RD STE 115 | ||||||||
| Address2: | |||||||||
| City: | GILBERT | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852962262 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4805072961 | ||||||||
| FaxNumber: | 4805072971 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/12/2016 | ||||||||
| LastUpdateDate: | 11/07/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 246ZC0007X | 160288 | N | Technologists, Technicians & Other Technical Service Providers | Specialist/Technologist, Other | Certified First Assistant | 363AS0400X | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical |
No ID Information.