Healthcare Provider Details

I. General information

NPI: 1437161908
Provider Name (Legal Business Name): LAYLA ANN HARTSFIELD-MOSHER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2006
Last Update Date: 05/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7725 N 43RD AVE STE 111
PHOENIX AZ
85051
US

IV. Provider business mailing address

9007 N 14TH DR
PHOENIX AZ
85021-2987
US

V. Phone/Fax

Practice location:
  • Phone: 623-931-9201
  • Fax: 623-931-2116
Mailing address:
  • Phone: 602-770-9053
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2875
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: