Healthcare Provider Details

I. General information

NPI: 1053538389
Provider Name (Legal Business Name): JAMIE LEE ENGSTROM PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2007
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14044 W CAMELBACK RD
LITCHFIELD PARK AZ
85340-9428
US

IV. Provider business mailing address

14044 W CAMELBACK RD
LITCHFIELD PARK AZ
85340-9428
US

V. Phone/Fax

Practice location:
  • Phone: 623-935-9600
  • Fax: 623-935-9602
Mailing address:
  • Phone: 623-935-9600
  • Fax: 623-935-9602

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2902
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: