Healthcare Provider Details

I. General information

NPI: 1598625030
Provider Name (Legal Business Name): TERESA LAGESON PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/17/2025
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5270 W BASELINE RD STE 145
LAVEEN AZ
85339-6959
US

IV. Provider business mailing address

20123 W MEDLOCK DR
LITCHFIELD PARK AZ
85340-9436
US

V. Phone/Fax

Practice location:
  • Phone: 623-267-5570
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number11326
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number11326
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: