Healthcare Provider Details

I. General information

NPI: 1346596079
Provider Name (Legal Business Name): ROBOTIC AND SURGICAL ASSISTANTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2012
Last Update Date: 03/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2313 PARKHAVEN DRIVE
PLANO TX
75075-2014
US

IV. Provider business mailing address

2313 PARKHAVEN DRIVE
PLANO TX
75075-2014
US

V. Phone/Fax

Practice location:
  • Phone: 682-738-8079
  • Fax: 682-738-8079
Mailing address:
  • Phone: 682-738-8079
  • Fax: 682-738-8079

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number631427
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA00025
License Number StateTX

VIII. Authorized Official

Name: DONNA J. OLSON
Title or Position: MANAGING PARTNER
Credential: PA-C
Phone: 682-738-8079