Healthcare Provider Details

I. General information

NPI: 1093926867
Provider Name (Legal Business Name): SOUTHEAST FIRST ASSISTANTS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 09/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 BURNSIDE TRL
HENDERSONVILLE NC
28792-8639
US

IV. Provider business mailing address

102 BURNSIDE TRL
HENDERSONVILLE NC
28792-8639
US

V. Phone/Fax

Practice location:
  • Phone: 828-272-6900
  • Fax: 828-272-9570
Mailing address:
  • Phone: 828-272-6900
  • Fax: 828-272-9570

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number143199
License Number StateNC

VIII. Authorized Official

Name: SUSAN JOHNSON
Title or Position: PRESIDENT
Credential: RNFA
Phone: 828-272-6900