MEDICARE: MS. SALLY A HARTZELL PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	2273	AZ

General Provider Information

NPI Number	:	1598722530
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SALLY A HARTZELL PA-C

Provider Business Mailing Address
First Line	:	2640 W. BASELINE RD
Second Line	:	SUITE 111
City	:	PHOENIX
State	:	AZ
Zip	:	85041
Country	:	US
Telephone Number	:	480-677-8282
Fax Number	:	480-677-8283

Provider Business Practice Location Address
First Line	:	2640 W BASELINE RD STE 111
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85041-6492
Country	:	US
Telephone Number	:	480-677-8282
Fax Number	:	480-677-8283

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/26/2006
Last Update Date	:	07/21/2022

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