Healthcare Provider Details

I. General information

NPI: 1265056337
Provider Name (Legal Business Name): AW FIRST ASSISTING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2020
Last Update Date: 06/03/2020
Certification Date: 06/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4301 CANADA PL NW
ALBUQUERQUE NM
87114-5638
US

IV. Provider business mailing address

4301 CANADA PL NW
ALBUQUERQUE NM
87114-5638
US

V. Phone/Fax

Practice location:
  • Phone: 505-400-1469
  • Fax: 505-792-9401
Mailing address:
  • Phone: 505-400-1469
  • Fax: 505-792-9401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number
License Number State

VIII. Authorized Official

Name: MRS. ANGELA A WINTERS
Title or Position: CERTIFIED SURGICAL FIRST ASSISTANT
Credential: CSFA
Phone: 505-400-1469