=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912243395
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NURSE PRACTITIONER SERVICES OF ARIZONA PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/12/2012
-----------------------------------------------------
Last Update Date | 12/12/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2735 S SEAN DR
-----------------------------------------------------
City | CHANDLER
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85286-4330
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 520-909-2466
-----------------------------------------------------
Fax | 480-629-5910
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2735 S SEAN DR
-----------------------------------------------------
City | CHANDLER
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85286-4330
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 520-909-2466
-----------------------------------------------------
Fax | 480-629-5910
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | WEI JEN SHEU
-----------------------------------------------------
Credential | ACNP
-----------------------------------------------------
Telephone | 520-909-2466
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------