Agave Surgical Services LLC
Nurse Practitioner, Acute Care in Mesa, AZ. Organization (NPI-2).
NPI number1477026862
StatusActive
Last updated in NPPESJan 8, 2019
Details
- NPI
- 1477026862
- Entity type
- Organization (NPI-2)
- Legal business name
- Agave Surgical Services LLC
- Organization subpart
- No
- Enumeration date
- Jan 8, 2019
- Last updated
- Jan 8, 2019
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363LA2100X | Nurse Practitioner, Acute Care | – | – | Yes |
Practice location
2045 S Vineyard Ste 142Mesa, AZ 85210-6891
Phone 480-330-6010
Mailing address
2045 S Vineyard Ste 142Mesa, AZ 85210-6891
Phone 480-330-6010
Authorized official
Bernadette Andalkar
Owner
5204908368
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