# ARIZONA MEDICAL BOUTIQUE, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1548462716
- **Authorized official:** SHUREE KRISTINE OLDEHOEFT PA-C (PHYSICIAN ASSISTANT)
- **Authorized official phone:** (480) 766-0550

## Contact information

- **Practice address:** 35017 N 30TH DR, PHOENIX, AZ 85086-3224
- **Practice address phone:** (480) 766-0550
- **Practice address fax:** (623) 581-7499
- **Mailing address:** 35017 N 30TH DR, PHOENIX, AZ 85086-3224
- **Mailing address phone:** (480) 766-0550
- **Mailing address fax:** (623) 581-7499

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 251K00000X | Public Health or Welfare Agency | 3164 | AZ | Yes |

## Other

- **Enumeration date:** 06/01/2007
- **Last updated:** 08/22/2020