Healthcare Provider Details

I. General information

NPI: 1447274345
Provider Name (Legal Business Name): JANELLE TIANNA HOPPES PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JANELLE TIANNA WALLACE PA-C

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 11/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1955 W GUADALUPE RD SUITE 1 & 2
MESA AZ
85202-7487
US

IV. Provider business mailing address

1250 S CLEARVIEW AVE SUITE 100
MESA AZ
85209-3378
US

V. Phone/Fax

Practice location:
  • Phone: 480-207-2990
  • Fax: 480-838-1541
Mailing address:
  • Phone: 480-207-2990
  • Fax: 480-838-1541

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2890
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number2890
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: