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General NPI Number Information
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NPI Number | 1598625030
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Entity Type | Individual
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Provider Name | TERESA LAGESON PA-C
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Gender | Female
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Dates
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Enumeration Date | 11/17/2025
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Last Update Date | 12/18/2025
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Provider Practice Location Address
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Address Line | 5270 W BASELINE RD STE 145
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City | LAVEEN
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State | AZ
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Zip | 85339-6959
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Country | US
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Telephone | 623-267-5570
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Fax |
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Provider Business Mailing Address
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Address Line | 20123 W MEDLOCK DR
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City | LITCHFIELD PARK
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State | AZ
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Zip | 85340-9436
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Country | US
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Telephone |
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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 | 11326
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 11326
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License Number State | AZ
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