Provider Demographics
NPI:1548383995
Name:VAN PATTEN, STEVEN EARL (PA-C)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:EARL
Last Name:VAN PATTEN
Suffix:
Gender:M
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 1:5757 W. THUNDERBIRD RD.
Mailing Address - Street 2:E255
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85306-4687
Mailing Address - Country:US
Mailing Address - Phone:602-843-1991
Mailing Address - Fax:602-843-3224
Practice Address - Street 1:5757 W. THUNDERBIRD RD.
Practice Address - Street 2:E255
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306-4687
Practice Address - Country:US
Practice Address - Phone:602-843-1991
Practice Address - Fax:602-843-3224
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2010-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2070363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ2070OtherPA LICENSE