Provider Demographics
NPI:1194730879
Name:STASSEN, DENISE M (PA-C)
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:M
Last Name:STASSEN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:DENISE
Other - Middle Name:
Other - Last Name:TEELING
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:15425 N GREENWAY HAYDEN LOOP
Mailing Address - Street 2:SUITE A-300-3
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-1204
Mailing Address - Country:US
Mailing Address - Phone:480-607-1124
Mailing Address - Fax:480-607-4988
Practice Address - Street 1:15425 N GREENWAY HAYDEN LOOP
Practice Address - Street 2:SUITE A-300-3
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-1204
Practice Address - Country:US
Practice Address - Phone:480-607-1124
Practice Address - Fax:480-607-4988
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2742363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS0905820OtherDEA NUMBER