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NPI Code Detail

MEDICARE: ELIZABETH V VESSELOVSKAYA PA-C

MEDICARE: ELIZABETH V VESSELOVSKAYA PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant6656AZ

General Provider Information

NPI Number : 1164961157
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELIZABETH V VESSELOVSKAYA PA-C
Provider Business Mailing Address
First Line : 14800 W MOUNTAIN VIEW BLVD STE 160
Second Line :
City : SURPRISE
State : AZ
Zip : 85374-2700
Country : US
Telephone Number : 623-584-3376
Fax Number : 623-584-3375
Provider Business Practice Location Address
First Line : 14800 W MOUNTAIN VIEW BLVD STE 160
Second Line :
City : SURPRISE
State : AZ
Zip : 85374-2700
Country : US
Telephone Number : 623-584-3376
Fax Number : 623-584-3375
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/23/2017
Last Update Date : 02/21/2018

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Directions to “ ELIZABETH V VESSELOVSKAYA PA-C” Practice Location

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