Healthcare Provider Details

I. General information

NPI: 1851790448
Provider Name (Legal Business Name): PHOENIX RN FIRST ASSISTANT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2014
Last Update Date: 08/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7328 N 22ND ST
PHOENIX AZ
85020-4753
US

IV. Provider business mailing address

PO BOX 32776
PHOENIX AZ
85064-2776
US

V. Phone/Fax

Practice location:
  • Phone: 480-545-2610
  • Fax: 480-545-2673
Mailing address:
  • Phone: 480-545-2610
  • Fax: 480-545-2673

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP5523
License Number StateAZ

VIII. Authorized Official

Name: DONNA GLEASON
Title or Position: OWNER
Credential: NP, CRNFA
Phone: 480-545-2610