Basic Information
| Provider Information | |||||||||
| NPI: | 1932724796 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FRANCIS | ||||||||
| FirstName: | SHAJU | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8424 E SHEA BLVD STE 101 | ||||||||
| Address2: | |||||||||
| City: | SCOTTSDALE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852606662 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4802561518 | ||||||||
| FaxNumber: | 4803043446 | ||||||||
| Practice Location | |||||||||
| Address1: | 8424 E SHEA BLVD STE 101 | ||||||||
| Address2: | |||||||||
| City: | SCOTTSDALE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852606662 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4802561518 | ||||||||
| FaxNumber: | 4803043446 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/08/2020 | ||||||||
| LastUpdateDate: | 02/15/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/30/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 155282 | AZ | N | Nursing Service Providers | Registered Nurse | 367500000X | 128154 | AZ | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | 1614952901 | 01 | AZ | ORGANIZATION NPI | OTHER |