MEDICARE: PHOENIX RN FIRST ASSISTANT LLC

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
1	363LF0000X	Family Nurse Practitioner	AP5523	AZ

General Provider Information

NPI Number	:	1851790448
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHOENIX RN FIRST ASSISTANT LLC

Provider Business Mailing Address
First Line	:	PO BOX 32776
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85064-2776
Country	:	US
Telephone Number	:	480-545-2610
Fax Number	:	480-545-2673

Provider Business Practice Location Address
First Line	:	7328 N 22ND ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85020-4753
Country	:	US
Telephone Number	:	480-545-2610
Fax Number	:	480-545-2673

Authorized Official
Title or Position	:	OWNER
Name	:	DONNA GLEASON
Credential	:	NP, CRNFA
Telephone Number	:	480-545-2610

Provider Enumeration Date	:	08/19/2014
Last Update Date	:	08/19/2014

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Directions to “PHOENIX RN FIRST ASSISTANT LLC ” Practice Location

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