Provider Demographics
NPI:1255177580
Name:ANNSAGOE LLC
Entity type:Organization
Organization Name:ANNSAGOE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:WILHELMINA
Authorized Official - Middle Name:
Authorized Official - Last Name:SAGOE ANNOR
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:602-803-7681
Mailing Address - Street 1:16155 N 83RD AVE STE 207
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85382-5815
Mailing Address - Country:US
Mailing Address - Phone:602-803-7681
Mailing Address - Fax:
Practice Address - Street 1:16155 N 83RD AVE STE 207
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382-5815
Practice Address - Country:US
Practice Address - Phone:602-803-7681
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:23-011022
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-07-05
Last Update Date:2024-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty