Provider Demographics
NPI:1508941915
Name:RADNOTHY, ANNE KATHERINE (PA-C)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:KATHERINE
Last Name:RADNOTHY
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:PO BOX 3147
Mailing Address - Street 2:YPG
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85365
Mailing Address - Country:US
Mailing Address - Phone:928-920-1322
Mailing Address - Fax:928-336-7520
Practice Address - Street 1:YRMC
Practice Address - Street 2:2400 S. AVE
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364
Practice Address - Country:US
Practice Address - Phone:928-336-7020
Practice Address - Fax:928-336-7520
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC103501363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant