Healthcare Provider Details

I. General information

NPI: 1235349168
Provider Name (Legal Business Name): DEBRA K HATTON CSFA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 10/17/2022
Certification Date: 10/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3684 E SIERRA MADRE AVE
GILBERT AZ
85296-1883
US

IV. Provider business mailing address

PO BOX 3710
GILBERT AZ
85299-3710
US

V. Phone/Fax

Practice location:
  • Phone: 480-703-4929
  • Fax:
Mailing address:
  • Phone: 480-703-4929
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: