Provider Demographics
NPI:1568086437
Name:NORTHERN ARIZONA SURGICAL ASSISTING LLC
Entity Type:Organization
Organization Name:NORTHERN ARIZONA SURGICAL ASSISTING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:A
Authorized Official - Last Name:DIEFENBACH
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:760-731-0313
Mailing Address - Street 1:4209 W INDIGO WAY
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-8228
Mailing Address - Country:US
Mailing Address - Phone:760-731-0313
Mailing Address - Fax:951-587-8277
Practice Address - Street 1:4209 W INDIGO WAY
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-8228
Practice Address - Country:US
Practice Address - Phone:760-731-0313
Practice Address - Fax:951-587-8277
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-05
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty