Provider Demographics
NPI:1538155874
Name:CARY, CHRISTINE ANN (PA)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:ANN
Last Name:CARY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 S DOBSON RD
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-5678
Mailing Address - Country:US
Mailing Address - Phone:480-814-1054
Mailing Address - Fax:480-814-1799
Practice Address - Street 1:2550 N THUNDERBIRD CIR STE 303
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85215-1219
Practice Address - Country:US
Practice Address - Phone:480-289-7890
Practice Address - Fax:480-924-8399
Is Sole Proprietor?:No
Enumeration Date:2005-09-22
Last Update Date:2011-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1903363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ444456Medicaid
AZ444456Medicaid
S45428Medicare UPIN