Healthcare Provider Details

I. General information

NPI: 1194730879
Provider Name (Legal Business Name): DENISE M STASSEN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DENISE TEELING

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15425 N GREENWAY HAYDEN LOOP SUITE A-300-3
SCOTTSDALE AZ
85260-1204
US

IV. Provider business mailing address

15425 N GREENWAY HAYDEN LOOP SUITE A-300-3
SCOTTSDALE AZ
85260-1204
US

V. Phone/Fax

Practice location:
  • Phone: 480-607-1124
  • Fax: 480-607-4988
Mailing address:
  • Phone: 480-607-1124
  • Fax: 480-607-4988

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2742
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: