# VIRGINIA PRENDERGAST LLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1295111987
- **Authorized official:** VIRGINIA PRENDERGAST (DIRECTOR)
- **Authorized official phone:** (480) 220-4688

## Contact information

- **Practice address:** 1424 E MARSHALL AVE, PHOENIX, AZ 85014-2358
- **Practice address phone:** (480) 220-4688
- **Practice address fax:** (602) 406-4969
- **Mailing address:** 1424 E MARSHALL AVE, PHOENIX, AZ 85014-2358
- **Mailing address phone:** (480) 220-4688
- **Mailing address fax:** (602) 406-4969

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LA2200X | Adult Health Nurse Practitioner | RN039088 | AZ | Yes |

## Other

- **Enumeration date:** 08/04/2015
- **Last updated:** 08/04/2015