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General NPI Number Information
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NPI Number | 1689645467
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Entity Type | Individual
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Provider Name | ABBY MICHELE NASTERNAK PA C
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Gender | Female
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Dates
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Enumeration Date | 01/30/2006
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Last Update Date | 01/14/2014
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Provider Practice Location Address
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Address Line | 9494 W NORTHERN AVE 101
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City | GLENDALE
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State | AZ
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Zip | 85305-1118
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Country | US
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Telephone | 623-872-2226
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Fax |
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Provider Business Mailing Address
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Address Line | 2550 N THUNDERBIRD CIR
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City | MESA
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State | AZ
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Zip | 85215-1214
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Country | US
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Telephone | 480-353-2235
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Fax | 480-776-0025
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 3033
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License Number State | AZ
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