Healthcare Provider Details

I. General information

NPI: 1164181939
Provider Name (Legal Business Name): MRS. ALLISON KATE TESTERMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALLISON KATE DAHLBERG

II. Dates (important events)

Enumeration Date: 12/09/2021
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18699 N 67TH AVE STE 120
GLENDALE AZ
85308-7141
US

IV. Provider business mailing address

PO BOX 18892
BELFAST ME
04915-4083
US

V. Phone/Fax

Practice location:
  • Phone: 623-242-1231
  • Fax:
Mailing address:
  • Phone: 469-893-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number11787
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: