Healthcare Provider Details

I. General information

NPI: 1215911334
Provider Name (Legal Business Name): TEANA KABACINSKI APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2005
Last Update Date: 04/13/2020
Certification Date: 04/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6601 W THOMAS RD
PHOENIX AZ
85033-5700
US

IV. Provider business mailing address

3003 N CENTRAL AVE STE 1600
PHOENIX AZ
85012-2908
US

V. Phone/Fax

Practice location:
  • Phone: 602-243-7277
  • Fax: 623-247-9742
Mailing address:
  • Phone: 602-323-3344
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number209001136
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number235181
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: