Provider Demographics
NPI:1144974395
Name:WADDELL FAMILY CARE PLLC
Entity type:Organization
Organization Name:WADDELL FAMILY CARE PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:KANDY
Authorized Official - Middle Name:LIZZETH
Authorized Official - Last Name:MEDINA PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:623-512-8308
Mailing Address - Street 1:7908 N COTTON LN
Mailing Address - Street 2:
Mailing Address - City:WADDELL
Mailing Address - State:AZ
Mailing Address - Zip Code:85355-9751
Mailing Address - Country:US
Mailing Address - Phone:623-512-8308
Mailing Address - Fax:
Practice Address - Street 1:13755 N LITCHFIELD RD STE 105
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85379-4288
Practice Address - Country:US
Practice Address - Phone:623-512-8308
Practice Address - Fax:949-437-2917
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-07
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care