Healthcare Provider Details

I. General information

NPI: 1174173181
Provider Name (Legal Business Name): BREANNE ELIZABETH DEMCHIK PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2019
Last Update Date: 03/23/2020
Certification Date: 03/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13755 N LITCHFIELD RD STE 105
SURPRISE AZ
85379-4288
US

IV. Provider business mailing address

13755 N LITCHFIELD RD STE 105
SURPRISE AZ
85379-4288
US

V. Phone/Fax

Practice location:
  • Phone: 623-322-5900
  • Fax:
Mailing address:
  • Phone: 602-322-5900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number7701
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: