Provider Demographics
NPI:1962699512
Name:AHWATUKEE DERMATOLOGY LLC
Entity type:Organization
Organization Name:AHWATUKEE DERMATOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:E
Authorized Official - Last Name:NEUMANN
Authorized Official - Suffix:
Authorized Official - Credentials:MMS, PA-C
Authorized Official - Phone:480-785-7546
Mailing Address - Street 1:4545 E CHANDLER BLVD
Mailing Address - Street 2:SUITE 305
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85048-7643
Mailing Address - Country:US
Mailing Address - Phone:480-785-7546
Mailing Address - Fax:480-940-1760
Practice Address - Street 1:4545 E CHANDLER BLVD
Practice Address - Street 2:SUITE 305
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85048-7643
Practice Address - Country:US
Practice Address - Phone:480-785-7546
Practice Address - Fax:480-940-1760
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-27
Last Update Date:2007-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ15963207N00000X
AZ2590363AM0700X
AZ151363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty