Provider Demographics
NPI:1558713495
Name:VIGILANCE ANESTHESIA SERVICES LLC
Entity Type:Organization
Organization Name:VIGILANCE ANESTHESIA SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:ISIOMA
Authorized Official - Middle Name:LEANNE
Authorized Official - Last Name:AGHACHI
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:248-686-4399
Mailing Address - Street 1:25742 SKYE CT
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48336-1661
Mailing Address - Country:US
Mailing Address - Phone:248-686-4399
Mailing Address - Fax:
Practice Address - Street 1:25742 SKYE CT
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48336-1661
Practice Address - Country:US
Practice Address - Phone:248-686-4399
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-03
Last Update Date:2016-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704253863367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty