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General NPI Number Information
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NPI Number | 1205029444
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Entity Type | Organization
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Legal Business Name | FIRST ASSISTANT, PRN
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Dates
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Enumeration Date | 08/21/2007
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Last Update Date | 08/21/2007
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Provider Practice Location Address
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Address Line | 12001 NW 5TH CT
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City | PLANTATION
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State | FL
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Zip | 33325-1817
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Country | US
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Telephone | 954-474-6755
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Fax | 954-916-6449
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Provider Business Mailing Address
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Address Line | 12001 NW 5TH CT
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City | PLANTATION
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State | FL
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Zip | 33325-1817
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Country | US
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Telephone | 954-474-6755
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Fax | 954-916-6449
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Authorized Official
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Title or Position | REGESTERED NURSE FIRST ASSISTANT
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Name | WANDA KEYES
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Credential | RNFA
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Telephone | 954-474-6755
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WR0006X
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Taxonomy Name | Registered Nurse First Assistant
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License Number | RN3409512
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License Number State | FL
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