Provider Demographics
NPI:1912759226
Name:DREXZELL PRIMARY CARE, PLLC
Entity Type:Organization
Organization Name:DREXZELL PRIMARY CARE, PLLC
Other - Org Name:DREXZELL PRIMARY CARE
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DREXZELL
Authorized Official - Middle Name:LAANNE
Authorized Official - Last Name:GLASKER
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, FNP
Authorized Official - Phone:520-849-5493
Mailing Address - Street 1:7350 E 22ND ST
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85710-6427
Mailing Address - Country:US
Mailing Address - Phone:520-849-5493
Mailing Address - Fax:
Practice Address - Street 1:7350 E 22ND ST
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85710-6427
Practice Address - Country:US
Practice Address - Phone:520-849-5493
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-02
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty