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General NPI Number Information
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NPI Number | 1144403429
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Entity Type | Individual
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Provider Name | GINA LINN ATHETIS FNP-C
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Gender | Female
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Dates
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Enumeration Date | 12/10/2007
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Last Update Date | 07/26/2010
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Provider Practice Location Address
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Address Line | 15425 N GREENWAY HAYDEN LOOP SUITE A300
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City | SCOTTSDALE
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State | AZ
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Zip | 85260-1204
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Country | US
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Telephone | 480-607-1124
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Fax | 480-607-1087
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Provider Business Mailing Address
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Address Line | 4350 N 19TH AVE SUITE 6
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City | PHOENIX
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State | AZ
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Zip | 85015-4602
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Country | US
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Telephone | 480-607-1124
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Fax | 480-607-1087
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | RN077817
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License Number State | AZ
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