MEDICARE: ATHENA MARIE ARBUCKLE

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	363A00000X	Physician Assistant	8045	AZ

General Provider Information

NPI Number	:	1700483898
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ATHENA MARIE ARBUCKLE

Provider Business Mailing Address
First Line	:	15000 N 83RD AVE UNIT 200
Second Line	:
City	:	PEORIA
State	:	AZ
Zip	:	85381-2002
Country	:	US
Telephone Number	:	623-887-2912
Fax Number	:

Provider Business Practice Location Address
First Line	:	15000 N 83RD AVE UNIT 200
Second Line	:
City	:	PEORIA
State	:	AZ
Zip	:	85381-2002
Country	:	US
Telephone Number	:	623-887-2912
Fax Number	:

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

Provider Enumeration Date	:	10/02/2020
Last Update Date	:	01/09/2026

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Directions to “ ATHENA MARIE ARBUCKLE ” Practice Location

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