Basic Information
| Provider Information | |||||||||
| NPI: | 1659686319 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FIRST ASSISTANT SURGICAL TEAM | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1689 | ||||||||
| Address2: | |||||||||
| City: | ETOWAH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287291689 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8288915524 | ||||||||
| FaxNumber: | 8288914069 | ||||||||
| Practice Location | |||||||||
| Address1: | 1034 KANUGA RD | ||||||||
| Address2: | |||||||||
| City: | HENDERSONVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287395624 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8286740781 | ||||||||
| FaxNumber: | 8288914069 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/18/2010 | ||||||||
| LastUpdateDate: | 08/18/2010 | ||||||||
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| AuthorizedOfficialLastName: | SHEEHAN | ||||||||
| AuthorizedOfficialFirstName: | JUDITH | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 8286740781 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | ANP-C | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2200X | 0050-03748 | NC | Y | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
No ID Information.