Individual
LINDA DIANE TEAGUE
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2963 W WHITE MOUNTAIN BLVD, LAKESIDE, AZ 85929-6257
(928) 368-0765
(928) 368-4540
Mailing address
2963 W WHITE MOUNTAIN BLVD, LAKESIDE, AZ 85929-6257
(928) 368-0765
(928) 368-4540
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA1883
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
194209
—
AZ
Enumeration date
04/28/2006
Last updated
07/08/2007
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