Provider Demographics
NPI:1730558644
Name:NEAL, ERICA MARIE (PA-C)
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:MARIE
Last Name:NEAL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:727 E MARIPOSA PL
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85225-0950
Mailing Address - Country:US
Mailing Address - Phone:602-677-5543
Mailing Address - Fax:
Practice Address - Street 1:2181 E PECOS RD STE 1
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85225-6140
Practice Address - Country:US
Practice Address - Phone:480-398-3638
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-21
Last Update Date:2015-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6183363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical