| Organization Name: | ARIZONA MEDICAL BOUTIQUE, LLC |
| NPI Number: | 1548462716 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | SHUREE KRISTINE OLDEHOEFT (PHYSICIAN ASSISTANT) |
| Mailing Address: | 35017 N 30th Dr Phoenix |
| State: | AZ US |
| Postal Code: | 850863224 |
| Phone Number: | 4807660550 |
| Fax Number: | 6235817499 |
| NPI Enumeration Date: | 06/01/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 251K00000X |
| License Number: | 3164 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | AZ |
| Taxonomy Type: | Agencies |
| Taxonomy Classification: | Public Health or Welfare |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |