Healthcare Provider Details

I. General information

NPI: 1730216862
Provider Name (Legal Business Name): ELIZABETH A. SAMELA RNFA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 10/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2122 E HIGHLAND AVE SUITE 300
PHOENIX AZ
85016-4739
US

IV. Provider business mailing address

2122 E HIGHLAND AVE SUITE 300
PHOENIX AZ
85016-4739
US

V. Phone/Fax

Practice location:
  • Phone: 602-553-3113
  • Fax: 602-667-7991
Mailing address:
  • Phone: 602-553-3113
  • Fax: 602-667-7991

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License NumberRN050269
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: