=====================================================
General NPI Number Information
=====================================================
NPI Number | 1508836784
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ROBYN ANNE SEARS PAC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/23/2006
-----------------------------------------------------
Last Update Date | 10/28/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1850 N CENTRAL AVE STE1600
-----------------------------------------------------
City | PHOENIX
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85004-4527
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 602-744-4765
-----------------------------------------------------
Fax | 602-744-4799
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1850 N CENTRAL AVE STE1600
-----------------------------------------------------
City | PHOENIX
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85004-4527
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 602-744-4765
-----------------------------------------------------
Fax | 602-744-4799
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363AM0700X
-----------------------------------------------------
Taxonomy Name | Medical Physician Assistant
-----------------------------------------------------
License Number | 2133
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------