Provider Demographics
NPI:1750545976
Name:TEAM 83 PARTNERS LLC
Entity type:Organization
Organization Name:TEAM 83 PARTNERS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT OF NUTRITION/WELLNES
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:CONNER
Authorized Official - Suffix:
Authorized Official - Credentials:MPH, RD, CDE, CFT
Authorized Official - Phone:623-561-2673
Mailing Address - Street 1:6320 W UNION HILLS DR
Mailing Address - Street 2:SUITE 1500 B
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-1096
Mailing Address - Country:US
Mailing Address - Phone:623-561-2673
Mailing Address - Fax:623-825-6315
Practice Address - Street 1:6320 W UNION HILLS DR.
Practice Address - Street 2:SUITE 1500 B
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308
Practice Address - Country:US
Practice Address - Phone:623-561-2673
Practice Address - Fax:623-825-6315
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-16
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ861117133VN1006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, MetabolicGroup - Single Specialty