Provider Demographics
NPI:1710330931
Name:ACCESSIMED HEALTHCARE SERVICES
Entity Type:Organization
Organization Name:ACCESSIMED HEALTHCARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:MANALO
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:480-326-5143
Mailing Address - Street 1:2204 E EVERGLADE LN
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85298-9750
Mailing Address - Country:US
Mailing Address - Phone:480-326-5143
Mailing Address - Fax:
Practice Address - Street 1:2204 E EVERGLADE LN
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85298-9750
Practice Address - Country:US
Practice Address - Phone:480-326-5143
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-22
Last Update Date:2016-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QP2300X
AZAP5299363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care