Provider Demographics
NPI:1710264189
Name:AWH SURGICAL FIRST ASSISTING INC.
Entity Type:Organization
Organization Name:AWH SURGICAL FIRST ASSISTING INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:HOVENDEN
Authorized Official - Suffix:
Authorized Official - Credentials:RNFA
Authorized Official - Phone:503-580-5163
Mailing Address - Street 1:1423 84TH PL SE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97317-9013
Mailing Address - Country:US
Mailing Address - Phone:503-580-5163
Mailing Address - Fax:503-390-7171
Practice Address - Street 1:1423 84TH PL SE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97317-9013
Practice Address - Country:US
Practice Address - Phone:503-580-5163
Practice Address - Fax:503-390-7171
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-13
Last Update Date:2011-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200641697RN163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First AssistantGroup - Single Specialty