Provider Demographics
NPI:1154671238
Name:KHATIB, LANA HUSSEIN (PA-C)
Entity Type:Individual
Prefix:MS
First Name:LANA
Middle Name:HUSSEIN
Last Name:KHATIB
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Gender:F
Credentials:PA-C
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Mailing Address - Street 1:1343 N ALMA SCHOOL RD
Mailing Address - Street 2:STE 160
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-5901
Mailing Address - Country:US
Mailing Address - Phone:480-588-7564
Mailing Address - Fax:480-374-5210
Practice Address - Street 1:15410 S MOUNTAIN PKWY
Practice Address - Street 2:SUITE 105
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85044-6691
Practice Address - Country:US
Practice Address - Phone:480-588-7564
Practice Address - Fax:480-374-5210
Is Sole Proprietor?:No
Enumeration Date:2012-09-14
Last Update Date:2016-05-20
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Provider Licenses
StateLicense IDTaxonomies
AZ5212363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical