Provider Demographics
NPI:1659746493
Name:FAIRMAN, RACHEL (PA-C)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:FAIRMAN
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 1:6520 W HAPPY VALLEY RD
Mailing Address - Street 2:SUITE B103
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85310-2615
Mailing Address - Country:US
Mailing Address - Phone:623-825-3700
Mailing Address - Fax:
Practice Address - Street 1:6520 W HAPPY VALLEY RD
Practice Address - Street 2:SUITE B103
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85310-2615
Practice Address - Country:US
Practice Address - Phone:623-825-3700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-04
Last Update Date:2017-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6293363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant