1851790448 NPI number — PHOENIX RN FIRST ASSISTANT LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851790448 NPI number — PHOENIX RN FIRST ASSISTANT LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PHOENIX RN FIRST ASSISTANT LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1851790448
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/14/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 32776
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHOENIX
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85064-2776
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-980-8206
Provider Business Mailing Address Fax Number:
480-281-5224

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7328 N 22ND ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85020-4753
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-980-8206
Provider Business Practice Location Address Fax Number:
480-281-5224
Provider Enumeration Date:
08/19/2014

Additional Information

Authorized Official

Authorized Official Last Name:
GLEASON
Authorized Official First Name:
DONNA
Authorized Official Middle Name:
J
Authorized Official Title or Position:
OWNER/NP
Authorized Official Telephone Number:
480-980-8206

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  AP5523 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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