Basic Information
| Provider Information | |||||||||
| NPI: | 1467711184 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ADG NURSING, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | P.O. BOX 3037 | ||||||||
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| City: | PINEDALE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 936503037 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5594360871 | ||||||||
| FaxNumber: | 5594365221 | ||||||||
| Practice Location | |||||||||
| Address1: | 303 S. HALCYON ROAD | ||||||||
| Address2: | |||||||||
| City: | ARROYO GRANDE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 934203817 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5594360871 | ||||||||
| FaxNumber: | 5594365221 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/15/2012 | ||||||||
| LastUpdateDate: | 05/15/2012 | ||||||||
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| AuthorizedOfficialLastName: | GOODMAN | ||||||||
| AuthorizedOfficialFirstName: | AMY | ||||||||
| AuthorizedOfficialMiddleName: | D. | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5594360871 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | CRNA | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | 2974 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.