Healthcare Provider Details

I. General information

NPI: 1285928721
Provider Name (Legal Business Name): NATHALIE TANIA PETEIN-ALAMSHAW MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NATHALIE TANIA PETEIN MD

II. Dates (important events)

Enumeration Date: 06/01/2011
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5555 W THUNDERBIRD ROAD
GLENDALE AZ
85306
US

IV. Provider business mailing address

5555 W THUNDERBIRD RD
GLENDALE AZ
85306-4622
US

V. Phone/Fax

Practice location:
  • Phone: 602-865-4195
  • Fax: 602-865-4393
Mailing address:
  • Phone: 602-865-4195
  • Fax: 602-865-3006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number48024
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number48024
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number48024
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: