Provider Demographics
NPI:1811979230
Name:HADLEY, JANE F (NP)
Entity type:Individual
Prefix:
First Name:JANE
Middle Name:F
Last Name:HADLEY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11209 N TATUM BLVD STE 260
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85028-6025
Mailing Address - Country:US
Mailing Address - Phone:602-494-6800
Mailing Address - Fax:
Practice Address - Street 1:11209 N TATUM BLVD
Practice Address - Street 2:SUITE 260
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85028-3091
Practice Address - Country:US
Practice Address - Phone:602-494-6800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-20
Last Update Date:2011-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP1442363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ459356Medicaid
AZP00348665OtherRAILROAD MEDICARE
AZP00348665OtherRAILROAD MEDICARE
AZ459356Medicaid
AZZ78166Medicare PIN