Healthcare Provider Details

I. General information

NPI: 1720315823
Provider Name (Legal Business Name): ANNA'S ASSISTING PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2009
Last Update Date: 05/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4401 E TUSCANY AVE
NAMPA ID
83686-5082
US

IV. Provider business mailing address

4401 E TUSCANY AVE
NAMPA ID
83686-5082
US

V. Phone/Fax

Practice location:
  • Phone: 208-880-0204
  • Fax:
Mailing address:
  • Phone: 208-880-0204
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number117520
License Number StateID

VIII. Authorized Official

Name: ANNA MAE STOIA
Title or Position: CERTIFIED FIRST ASSIST
Credential: CST, CFA
Phone: 208-880-0204