Healthcare Provider Details

I. General information

NPI: 1760233894
Provider Name (Legal Business Name): MEDICAL 911 LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2024
Last Update Date: 02/20/2025
Certification Date: 02/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5925 E SOUTHERN AVE STE 100
MESA AZ
85206-3620
US

IV. Provider business mailing address

5925 E SOUTHERN AVE STE 100
MESA AZ
85206-3620
US

V. Phone/Fax

Practice location:
  • Phone: 602-576-9291
  • Fax: 602-431-2149
Mailing address:
  • Phone: 602-576-9291
  • Fax: 602-431-2149

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: ANGELA OAKLEY
Title or Position: FNP
Credential: FNP
Phone: 602-576-9291