Healthcare Provider Details

I. General information

NPI: 1649450792
Provider Name (Legal Business Name): MRS. ANN HASTINGS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2007
Last Update Date: 11/06/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2701 W MEMORIAL DR
ANTHEM AZ
85086-4955
US

IV. Provider business mailing address

2701 W MEMORIAL DR
ANTHEM AZ
85086-4955
US

V. Phone/Fax

Practice location:
  • Phone: 623-445-7401
  • Fax: 623-445-7480
Mailing address:
  • Phone: 623-445-7401
  • Fax: 623-445-7480

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: