Healthcare Provider Details

I. General information

NPI: 1710264189
Provider Name (Legal Business Name): AWH SURGICAL FIRST ASSISTING INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2011
Last Update Date: 11/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1423 84TH PL SE
SALEM OR
97317-9013
US

IV. Provider business mailing address

1423 84TH PL SE
SALEM OR
97317-9013
US

V. Phone/Fax

Practice location:
  • Phone: 503-580-5163
  • Fax: 503-390-7171
Mailing address:
  • Phone: 503-580-5163
  • Fax: 503-390-7171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number200641697RN
License Number StateOR

VIII. Authorized Official

Name: ALISHA HOVENDEN
Title or Position: OWNER
Credential: RNFA
Phone: 503-580-5163