Provider Demographics
NPI:1073569083
Name:DEMASTERS, LYNN ADAIR (PA)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:ADAIR
Last Name:DEMASTERS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:LYNN
Other - Middle Name:ADAIR
Other - Last Name:LUNDQUIST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:20201 N SCOTTSDALE HEALTHCARE DR
Mailing Address - Street 2:STE 280
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255-4134
Mailing Address - Country:US
Mailing Address - Phone:480-272-6344
Mailing Address - Fax:480-307-9327
Practice Address - Street 1:20201 N SCOTTSDALE HEALTHCARE DR
Practice Address - Street 2:STE 280
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85255-4134
Practice Address - Country:US
Practice Address - Phone:480-272-6344
Practice Address - Fax:480-307-9327
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2014-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPA333363A00000X
AZ3780363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ633029Medicaid
AZZ147383Medicare PIN
AZZ147382Medicare PIN
P26425Medicare UPIN