Provider Demographics
NPI:1083691315
Name:FAHS, NATALIE LYNN (PA-C)
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:LYNN
Last Name:FAHS
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 1:1839 S ALMA SCHOOL RD STE 354
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85210-3028
Mailing Address - Country:US
Mailing Address - Phone:480-726-2287
Mailing Address - Fax:888-503-3312
Practice Address - Street 1:3011 S LINDSAY RD STE 101
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85295
Practice Address - Country:US
Practice Address - Phone:480-726-2500
Practice Address - Fax:480-726-2131
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-28
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ70349500001320600000X
AZ7057360001332B00000X
AZ8220410001332B00000X
AZ7046960001332B00000X
AZ704516001332B00000X
AZ7209350001332B00000X
AZ7047150001332B00000X
AZ7939960001332B00000X
AZ7629170001332B00000X
AZ6093363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA50044430OtherCAPITAL BLUE CROSS
PA91456OtherPA BLUE SHIELD
PA50044430OtherCAPITAL BLUE CROSS
PAP00735Medicare UPIN