Healthcare Provider Details

I. General information

NPI: 1750545976
Provider Name (Legal Business Name): TEAM 83 PARTNERS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2008
Last Update Date: 07/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6320 W UNION HILLS DR. SUITE 1500 B
GLENDALE AZ
85308
US

IV. Provider business mailing address

6320 W UNION HILLS DR SUITE 1500 B
GLENDALE AZ
85308-1096
US

V. Phone/Fax

Practice location:
  • Phone: 623-561-2673
  • Fax: 623-825-6315
Mailing address:
  • Phone: 623-561-2673
  • Fax: 623-825-6315

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License Number861117
License Number StateAZ

VIII. Authorized Official

Name: ANDREA SUE CONNER
Title or Position: VICE PRESIDENT OF NUTRITION/WELLNES
Credential: MPH, RD, CDE, CFT
Phone: 623-561-2673