Provider Demographics
NPI:1366142887
Name:PRIMROSE PRIMARY CARE AND WELLNESS
Entity type:Organization
Organization Name:PRIMROSE PRIMARY CARE AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY MEDICINE PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:A
Authorized Official - Last Name:TATUM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:309-261-3784
Mailing Address - Street 1:10715 N FRANK LLOYD WRIGHT BLVD STE 107
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85259-2691
Mailing Address - Country:US
Mailing Address - Phone:480-860-5533
Mailing Address - Fax:480-860-5005
Practice Address - Street 1:10715 N FRANK LLOYD WRIGHT BLVD STE 107
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85259-2691
Practice Address - Country:US
Practice Address - Phone:480-860-5533
Practice Address - Fax:480-860-5005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-03
Last Update Date:2023-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty