Basic Information
| Provider Information | |||||||||
| NPI: | 1831376128 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HEALTH PARTNERS PLUS LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 20165 N 67TH AVE STE 122A | ||||||||
| Address2: | PMB 147 | ||||||||
| City: | GLENDALE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853087155 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6235845626 | ||||||||
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| Practice Location | |||||||||
| Address1: | 20165 N 67TH AVE STE 122A | ||||||||
| Address2: | PMB 147 | ||||||||
| City: | GLENDALE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853087155 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6235845626 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/29/2008 | ||||||||
| LastUpdateDate: | 03/19/2013 | ||||||||
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| AuthorizedOfficialLastName: | POLSON | ||||||||
| AuthorizedOfficialFirstName: | PATRICIA | ||||||||
| AuthorizedOfficialMiddleName: | S. | ||||||||
| AuthorizedOfficialTitleorPosition: | PROVIDER | ||||||||
| AuthorizedOfficialTelephone: | 6235845626 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MSN/FNP, CRNFA | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 1912990094 | 01 | AZ | AHCCCS | OTHER | P0185990 | 01 | AZ | BCBS OUT OF AREA | OTHER | 5124334 | 01 | AZ | AETNA | OTHER | 730511 | 01 | AZ | UNITED HEALTHCARE | OTHER | 2Z3248 | 01 | AZ | HEALTHNET | OTHER |