Provider Demographics
NPI:1437434602
Name:DRAMARETSKA, VICKY (PA-C)
Entity Type:Individual
Prefix:
First Name:VICKY
Middle Name:
Last Name:DRAMARETSKA
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 1:5750 W THUNDERBIRD RD
Mailing Address - Street 2:SUITE F-640
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85306-4691
Mailing Address - Country:US
Mailing Address - Phone:480-300-6065
Mailing Address - Fax:855-923-0899
Practice Address - Street 1:5750 W THUNDERBIRD RD
Practice Address - Street 2:SUITE F-640
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306-4691
Practice Address - Country:US
Practice Address - Phone:480-300-6065
Practice Address - Fax:855-923-0899
Is Sole Proprietor?:No
Enumeration Date:2011-10-19
Last Update Date:2020-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5056363A00000X, 363AM0700X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical