Provider Demographics
NPI:1164601811
Name:ARIZONA STATE UNIVERSITY
Entity Type:Organization
Organization Name:ARIZONA STATE UNIVERSITY
Other - Org Name:ASU BREAKING THE CYCLE COMMUNITY HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASSOC. DEAN FOR CLINICAL PRACTICE
Authorized Official - Prefix:DR
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:GIANNASCOLI
Authorized Official - Last Name:LINK
Authorized Official - Suffix:
Authorized Official - Credentials:NURSE PRACTITIONER
Authorized Official - Phone:602-496-0893
Mailing Address - Street 1:500 N 3RD ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85004-2135
Mailing Address - Country:US
Mailing Address - Phone:602-523-9275
Mailing Address - Fax:
Practice Address - Street 1:1124 N 3RD ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85004-1805
Practice Address - Country:US
Practice Address - Phone:602-523-9275
Practice Address - Fax:602-258-4345
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ARIZONA STATE UNIVERSITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-10-30
Last Update Date:2009-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ261QA0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0005XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Family Planning Facility