Basic Information
| Provider Information | |||||||||
| NPI: | 1326015165 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ARMSTRONG | ||||||||
| FirstName: | PATRICIA | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 29862 | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850389862 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6024331822 | ||||||||
| FaxNumber: | 6022467060 | ||||||||
| Practice Location | |||||||||
| Address1: | 1300 N 12TH ST | ||||||||
| Address2: | 301 | ||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850062848 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6028396968 | ||||||||
| FaxNumber: | 6028394144 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/01/2006 | ||||||||
| LastUpdateDate: | 08/23/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363A00000X | 2416 | AZ | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | 72107 | 01 | PIN | OTHER | 100612 | 01 | PIN | OTHER | 72105 | 01 | PIN | OTHER | 733619 | 05 | AZ | MEDICAID | 72106 | 01 | PIN | OTHER | 72104 | 01 | PIN | OTHER |