Basic Information
| Provider Information | |||||||||
| NPI: | 1801135108 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PATIN | ||||||||
| FirstName: | TERESA | ||||||||
| MiddleName: | JUNE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1661 E CAMELBACK RD STE 200 | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850163913 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6024229000 | ||||||||
| FaxNumber: | 6025565951 | ||||||||
| Practice Location | |||||||||
| Address1: | 4530 E RAY RD STE 125 | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850446096 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4807599191 | ||||||||
| FaxNumber: | 4807599105 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/06/2013 | ||||||||
| LastUpdateDate: | 04/07/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/07/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LW0102X | AP7512 | AZ | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Women's Health |
No ID Information.