Provider Demographics
NPI:1639956238
Name:SURGENOR, NELIA C
Entity Type:Individual
Prefix:
First Name:NELIA
Middle Name:C
Last Name:SURGENOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 S SUNSET CT
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85225-6810
Mailing Address - Country:US
Mailing Address - Phone:480-323-0420
Mailing Address - Fax:480-659-2766
Practice Address - Street 1:1764 W SAN TAN ST
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-8236
Practice Address - Country:US
Practice Address - Phone:480-323-0420
Practice Address - Fax:480-659-2766
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-08
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility