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General NPI Number Information
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NPI Number | 1700692407
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Entity Type | Individual
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Provider Name | HAILEY MICHELLE LUNDQUIST PA
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Gender | Female
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Dates
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Enumeration Date | 12/06/2024
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Last Update Date | 09/26/2025
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Provider Practice Location Address
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Address Line | 5777 E MAYO BLVD
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City | PHOENIX
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State | AZ
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Zip | 85054-4502
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Country | US
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Telephone | 480-342-2000
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Fax |
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Provider Business Mailing Address
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Address Line | 10441 E LOMITA AVE
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City | MESA
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State | AZ
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Zip | 85209-1599
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Country | US
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Telephone | 253-244-2850
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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 | 11253
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License Number State | AZ
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