Provider Demographics
NPI:1124047246
Name:PINDER, THERESA ELIZABETH (PA-C)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:ELIZABETH
Last Name:PINDER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6970 E CHAUNCEY LN STE 100
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85054-5158
Mailing Address - Country:US
Mailing Address - Phone:602-788-7211
Mailing Address - Fax:602-788-1890
Practice Address - Street 1:6970 E CHAUNCEY LN STE 100
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85054-5158
Practice Address - Country:US
Practice Address - Phone:602-788-7211
Practice Address - Fax:602-788-1890
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2496363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZP39784Medicare UPIN