Provider Demographics
NPI:1386914570
Name:RADDATZ, ANNETTE MARIE
Entity type:Individual
Prefix:
First Name:ANNETTE
Middle Name:MARIE
Last Name:RADDATZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15300 N. 90TH ST.
Mailing Address - Street 2:STE. #950
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260
Mailing Address - Country:US
Mailing Address - Phone:480-941-2147
Mailing Address - Fax:480-941-2157
Practice Address - Street 1:15300 N. 90TH ST.
Practice Address - Street 2:STE. #950
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260
Practice Address - Country:US
Practice Address - Phone:480-941-2147
Practice Address - Fax:480-941-2157
Is Sole Proprietor?:No
Enumeration Date:2012-01-05
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0801171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist