Healthcare Provider Details

I. General information

NPI: 1043854623
Provider Name (Legal Business Name): DEE ALLEY ENSIGN PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2019
Last Update Date: 01/21/2020
Certification Date: 01/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16601 N 40TH ST STE 227
PHOENIX AZ
85032-3354
US

IV. Provider business mailing address

16601 N 40TH ST STE 227
PHOENIX AZ
85032-3354
US

V. Phone/Fax

Practice location:
  • Phone: 602-633-3721
  • Fax: 602-595-1127
Mailing address:
  • Phone: 602-633-3721
  • Fax: 602-595-1127

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number7632
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: