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General NPI Number Information
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NPI Number | 1457097552
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Entity Type | Individual
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Provider Name | MADELYN GARD
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Gender | Female
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Dates
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Enumeration Date | 05/11/2022
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Last Update Date | 01/05/2023
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Provider Practice Location Address
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Address Line | 21001 N TATUM BLVD
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City | PHOENIX
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State | AZ
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Zip | 85050-4206
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Country | US
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Telephone | 877-222-5348
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Fax |
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Provider Business Mailing Address
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Address Line | 4901 E KELTON LN UNIT 1062
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City | SCOTTSDALE
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State | AZ
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Zip | 85254-1005
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Country | US
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Telephone | 623-466-5202
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Fax |
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 9111
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License Number State |
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