Healthcare Provider Details

I. General information

NPI: 1457476582
Provider Name (Legal Business Name): ELAINE M NUEMAN P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 01/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1818 E SKY HARBOR CIR N SUITE 150
PHOENIX AZ
85034-3407
US

IV. Provider business mailing address

5080 SPECTRUM DR SUITE 1200 WEST
ADDISON TX
75001-4648
US

V. Phone/Fax

Practice location:
  • Phone: 602-244-9500
  • Fax: 602-244-9543
Mailing address:
  • Phone: 972-364-8000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2017
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: