Glick, Shantel Tanae

Glick, Shantel Tanae is an sole proprietor health care provider with primary practice located at 21681 N 77Th Ave , Peoria AZ 85382-2132. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, which is considered as her primary health care specialty. Glick, Shantel Tanae can be contacted via phone (623) 972-9200.

Contact Information

Primary practice address
21681 N 77Th Ave Peoria AZ 85382-2132
Phone: (623) 972-9200
Fax: (623) 972-9209
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X AZ3142 Arizona

Profile Details

NPI number 1841342631
LBN Legal business name Glick, Shantel Tanae
Credentials Physician's Assistant Certified (PA-C)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jan 18th, 2007
Last updated May 20th, 2015 - about 11 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1841342631 NPPES
Arizona MEDICAID 920513
Arizona Other Z159355

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