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General NPI Number Information
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NPI Number | 1447849963
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Entity Type | Organization
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Legal Business Name | DARK SKY ASSIST
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Dates
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Enumeration Date | 01/11/2021
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Last Update Date | 08/02/2023
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Provider Practice Location Address
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Address Line | 1475 FOREST VW W
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City | PRESCOTT
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State | AZ
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Zip | 86305-5118
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Country | US
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Telephone | 928-310-6333
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Fax |
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Provider Business Mailing Address
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Address Line | 1475 FOREST VW W
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City | PRESCOTT
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State | AZ
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Zip | 86305-5118
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Country | US
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Telephone | 928-310-3333
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Fax |
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Authorized Official
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Title or Position | FNP
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Name | ELISA A VENEZIA
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Credential | FNP/RNFA
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Telephone | 928-310-6333
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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