=====================================================
General NPI Number Information
=====================================================
NPI Number | 1891829909
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LYNAIA HOOGEWERF P.A.-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/14/2007
-----------------------------------------------------
Last Update Date | 06/07/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5233 E SOUTHERN AVE STE 104
-----------------------------------------------------
City | MESA
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85206-3628
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-567-5267
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8380 W EMILE ZOLA AVE UNIT 5118
-----------------------------------------------------
City | PEORIA
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85385-2006
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 602-529-4800
-----------------------------------------------------
Fax | 602-529-4799
-----------------------------------------------------
=====================================================
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 | 3259
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------