Provider Demographics
NPI:1205029444
Name:FIRST ASSISTANT, PRN
Entity Type:Organization
Organization Name:FIRST ASSISTANT, PRN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGESTERED NURSE FIRST ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:WANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:KEYES
Authorized Official - Suffix:
Authorized Official - Credentials:RNFA
Authorized Official - Phone:954-474-6755
Mailing Address - Street 1:12001 NW 5TH CT
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33325-1817
Mailing Address - Country:US
Mailing Address - Phone:954-474-6755
Mailing Address - Fax:954-916-6449
Practice Address - Street 1:12001 NW 5TH CT
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33325-1817
Practice Address - Country:US
Practice Address - Phone:954-474-6755
Practice Address - Fax:954-916-6449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-21
Last Update Date:2007-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN3409512163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First AssistantGroup - Single Specialty