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General NPI Number Information
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NPI Number | 1487956504
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Entity Type | Organization
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Legal Business Name | NORTHEASTERN ANESTHESIA PLLC
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Dates
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Enumeration Date | 11/22/2010
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Last Update Date | 11/25/2025
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Provider Practice Location Address
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Address Line | 5700 E HIGHWAY 90
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City | SIERRA VISTA
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State | AZ
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Zip | 85635-9110
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Country | US
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Telephone | 520-263-3835
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Fax | 520-263-3919
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Provider Business Mailing Address
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Address Line | PO BOX 34120
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City | RENO
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State | NV
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Zip | 89533-4120
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Country | US
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Telephone | 877-747-5050
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Fax | 775-747-5005
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Authorized Official
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Title or Position | OWNER
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Name | JOSEPH WILLIAM MARTIN
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Credential | CRNA
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Telephone | 559-289-4574
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number |
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License Number State |
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