Healthcare Provider Details

I. General information

NPI: 1760527725
Provider Name (Legal Business Name): NORTH VALLEY SURGICAL ASSISTING, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 04/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4150 W. PEORIA AVE STE 121
PHOENIX AZ
85029
US

IV. Provider business mailing address

POB 83270
PHOENIX AZ
85071-3270
US

V. Phone/Fax

Practice location:
  • Phone: 602-622-1929
  • Fax: 602-942-6188
Mailing address:
  • Phone: 602-622-1929
  • Fax: 602-942-6188

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License NumberRN101426
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name: SHERRI ANN MEADOR
Title or Position: CRNFA/PRESIDENT OF NVALLEY SURGICAL
Credential: CRNFA
Phone: 602-622-1929