Healthcare Provider Details

I. General information

NPI: 1881168656
Provider Name (Legal Business Name): VIRTUOUS ANESTHESIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2019
Last Update Date: 06/28/2022
Certification Date: 06/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11811 N TATUM BLVD STE 3031
PHOENIX AZ
85028-1621
US

IV. Provider business mailing address

11811 N TATUM BLVD STE 3031-67
PHOENIX AZ
85028-1614
US

V. Phone/Fax

Practice location:
  • Phone: 480-213-8488
  • Fax:
Mailing address:
  • Phone: 602-903-0360
  • Fax: 602-889-5434

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: SUSAN NANCE
Title or Position: COO
Credential: RN
Phone: 602-903-0360