Provider Demographics
NPI:1700483898
Name:ARBUCKLE, ATHENA MARIE
Entity Type:Individual
Prefix:
First Name:ATHENA
Middle Name:MARIE
Last Name:ARBUCKLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14638 N 43RD PL
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-4773
Mailing Address - Country:US
Mailing Address - Phone:928-951-4281
Mailing Address - Fax:
Practice Address - Street 1:3815 E BELL RD STE 3600
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-2166
Practice Address - Country:US
Practice Address - Phone:623-935-5522
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-02
Last Update Date:2020-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8045363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant