Healthcare Provider Details

I. General information

NPI: 1144403429
Provider Name (Legal Business Name): GINA LINN ATHETIS FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2007
Last Update Date: 07/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15425 N GREENWAY HAYDEN LOOP SUITE A300
SCOTTSDALE AZ
85260-1204
US

IV. Provider business mailing address

4350 N 19TH AVE SUITE 6
PHOENIX AZ
85015-4602
US

V. Phone/Fax

Practice location:
  • Phone: 480-607-1124
  • Fax: 480-607-1087
Mailing address:
  • Phone: 480-607-1124
  • Fax: 480-607-1087

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN077817
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: