Provider Demographics
NPI:1811292923
Name:PHOENIX VA MEDICAL CENTER
Entity type:Organization
Organization Name:PHOENIX VA MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AMBULATORY CARE NURSE PRACTITIONER
Authorized Official - Prefix:MS
Authorized Official - First Name:EVA
Authorized Official - Middle Name:SUSAN
Authorized Official - Last Name:DABROWSKA MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:602-277-5551
Mailing Address - Street 1:4232 N 31ST ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-5819
Mailing Address - Country:US
Mailing Address - Phone:602-380-1321
Mailing Address - Fax:602-200-6289
Practice Address - Street 1:650 E INDIAN SCHOOL RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85012-1839
Practice Address - Country:US
Practice Address - Phone:602-277-5551
Practice Address - Fax:602-200-6289
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-20
Last Update Date:2011-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QV0200XAmbulatory Health Care FacilitiesClinic/CenterVA