=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538301759
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ASAP NURSING LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/02/2009
-----------------------------------------------------
Last Update Date | 04/22/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 268 MISSOURI AVE S
-----------------------------------------------------
City | SALEM
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97302-4564
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 503-569-4724
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 268 MISSOURI AVE S
-----------------------------------------------------
City | SALEM
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97302-4564
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 503-569-4724
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | ANDREA IVANNIA ABURTO
-----------------------------------------------------
Credential | RN
-----------------------------------------------------
Telephone | 503-569-4724
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251J00000X
-----------------------------------------------------
Taxonomy Name | Nursing Care Agency
-----------------------------------------------------
License Number | 200842119RN
-----------------------------------------------------
License Number State | OR
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 163WC1500X
-----------------------------------------------------
Taxonomy Name | Community Health Registered Nurse
-----------------------------------------------------
License Number | 200842119RN
-----------------------------------------------------
License Number State | OR
-----------------------------------------------------