Provider Demographics
NPI:1891786422
Name:BRONTSEMA, KIMBERLEE J (PA-C)
Entity Type:Individual
Prefix:
First Name:KIMBERLEE
Middle Name:J
Last Name:BRONTSEMA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KIMBERLEE
Other - Middle Name:J
Other - Last Name:BRONTSEMA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA-C
Mailing Address - Street 1:9328 E RAINTREE DR
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-2098
Mailing Address - Country:US
Mailing Address - Phone:602-268-8463
Mailing Address - Fax:602-266-0122
Practice Address - Street 1:9328 E RAINTREE DR
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-2098
Practice Address - Country:US
Practice Address - Phone:602-268-8463
Practice Address - Fax:602-266-0122
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2737363A00000X, 207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant