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General NPI Number Information
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NPI Number | 1477892883
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Entity Type | Organization
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Legal Business Name | ADJUVANTAGE SURGICAL ASSIST INC.
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Dates
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Enumeration Date | 02/05/2013
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Last Update Date | 02/05/2013
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Provider Practice Location Address
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Address Line | 3314 STRAITS CT
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City | ROWLETT
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State | TX
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Zip | 75088-8336
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Country | US
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Telephone | 214-227-2457
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Fax | 214-764-0880
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Provider Business Mailing Address
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Address Line | 3314 STRAITS CT
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City | ROWLETT
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State | TX
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Zip | 75088-8336
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Country | US
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Telephone | 214-227-2457
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Fax | 214-764-0880
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Authorized Official
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Title or Position | OWNER
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Name | MS. ALISHA BRAY
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Credential | RNFA
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Telephone | 214-227-2457
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WM0705X
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Taxonomy Name | Medical-Surgical Registered Nurse
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License Number | 747191
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License Number State | TX
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