Provider Demographics
NPI:1235604299
Name:NORTHERN NURSING ANESTHESIA SERVICES PC
Entity Type:Organization
Organization Name:NORTHERN NURSING ANESTHESIA SERVICES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:D
Authorized Official - Last Name:NORTHERN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:831-800-7887
Mailing Address - Street 1:1172 S MAIN ST STE 346
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93901-2204
Mailing Address - Country:US
Mailing Address - Phone:831-800-7887
Mailing Address - Fax:831-998-7155
Practice Address - Street 1:243 GREEN VALLEY RD STE F
Practice Address - Street 2:
Practice Address - City:FREEDOM
Practice Address - State:CA
Practice Address - Zip Code:95019-3133
Practice Address - Country:US
Practice Address - Phone:831-800-7887
Practice Address - Fax:831-998-7155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-05
Last Update Date:2020-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty