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NPI Code Detail

MEDICARE: TEANA KABACINSKI APN

MEDICARE: TEANA KABACINSKI APN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LW0102XWomen's Health Nurse Practitioner209001136IL
2363LW0102XWomen's Health Nurse Practitioner235181AZ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2209001136OTHERILLICENSE

General Provider Information

NPI Number : 1215911334
Entity Type Code : Individual
Provider Name (Legal Business Name) : TEANA KABACINSKI APN
Provider Business Mailing Address
First Line : 3003 N CENTRAL AVE STE 1600
Second Line :
City : PHOENIX
State : AZ
Zip : 85012-2908
Country : US
Telephone Number : 602-323-3344
Fax Number :
Provider Business Practice Location Address
First Line : 6601 W THOMAS RD
Second Line :
City : PHOENIX
State : AZ
Zip : 85033-5700
Country : US
Telephone Number : 602-243-7277
Fax Number : 623-247-9742
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/01/2005
Last Update Date : 04/13/2020

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