Provider Demographics
NPI:1386439354
Name:FENSKE, MEGHAN MAUREEN (PA-C)
Entity type:Individual
Prefix:
First Name:MEGHAN
Middle Name:MAUREEN
Last Name:FENSKE
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 1:5757 W THUNDERBIRD RD STE E151
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85306-4685
Mailing Address - Country:US
Mailing Address - Phone:605-593-2316
Mailing Address - Fax:
Practice Address - Street 1:5757 W THUNDERBIRD RD STE E151
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306-4685
Practice Address - Country:US
Practice Address - Phone:602-865-4570
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-10
Last Update Date:2025-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ11365363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical