Provider Demographics
NPI:1871573808
Name:VANPATTEN, PENNY A (PA-C)
Entity type:Individual
Prefix:
First Name:PENNY
Middle Name:A
Last Name:VANPATTEN
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 1:20401 N 73RD ST STE 135
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255-4148
Mailing Address - Country:US
Mailing Address - Phone:480-305-0034
Mailing Address - Fax:480-305-0349
Practice Address - Street 1:20401 N 73RD ST STE 135
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85255-4148
Practice Address - Country:US
Practice Address - Phone:480-305-0034
Practice Address - Fax:480-305-0349
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-17
Last Update Date:2020-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPA889363A00000X
CAPA51514363A00000X
AZ2168363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant