Basic Information
| Provider Information | |||||||||
| NPI: | 1811292923 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PHOENIX VA MEDICAL CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4232 N 31ST ST | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850165819 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6023801321 | ||||||||
| FaxNumber: | 6022006289 | ||||||||
| Practice Location | |||||||||
| Address1: | 650 E INDIAN SCHOOL RD | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850121839 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6022775551 | ||||||||
| FaxNumber: | 6022006289 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/20/2011 | ||||||||
| LastUpdateDate: | 01/20/2011 | ||||||||
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| AuthorizedOfficialLastName: | DABROWSKA MILLER | ||||||||
| AuthorizedOfficialFirstName: | EVA | ||||||||
| AuthorizedOfficialMiddleName: | SUSAN | ||||||||
| AuthorizedOfficialTitleorPosition: | AMBULATORY CARE NURSE PRACTITIONER | ||||||||
| AuthorizedOfficialTelephone: | 6022775551 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | FNP-C | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QV0200X | Y | Ambulatory Health Care Facilities | Clinic/Center | VA |
No ID Information.