Basic Information
| Provider Information | |||||||||
| NPI: | 1386380566 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | JLA ANESTHESIA SERVICES PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11022 N 28TH DR STE 100 | ||||||||
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| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850295634 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6024247967 | ||||||||
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| Practice Location | |||||||||
| Address1: | 19052 N R H JOHNSON BLVD | ||||||||
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| City: | SUN CITY WEST | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853754401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6239752020 | ||||||||
| FaxNumber: | 6239757005 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/10/2022 | ||||||||
| LastUpdateDate: | 05/10/2022 | ||||||||
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| AuthorizedOfficialLastName: | ANDERSON | ||||||||
| AuthorizedOfficialFirstName: | JOANNE | ||||||||
| AuthorizedOfficialMiddleName: | LYNNE | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER, CRNA | ||||||||
| AuthorizedOfficialTelephone: | 8132633195 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | CRNA | ||||||||
| NPICertificationDate: | 05/10/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.