Provider Demographics
NPI:1700256534
Name:DETHLEFS, ALISON FAYE (NP)
Entity type:Individual
Prefix:MRS
First Name:ALISON
Middle Name:FAYE
Last Name:DETHLEFS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:ALISON
Other - Middle Name:FAYE
Other - Last Name:CHANDLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:15345 N SCOTTSDALE RD UNIT 1039
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-3008
Mailing Address - Country:US
Mailing Address - Phone:480-980-3565
Mailing Address - Fax:
Practice Address - Street 1:15025 N THOMPSON PEAK PKWY
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-2863
Practice Address - Country:US
Practice Address - Phone:855-925-4733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-06
Last Update Date:2019-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024172960363LF0000X
AZAP8873363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily