Organization
NWSE: NICOLE WARNER SHAHA ENTERPRISES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. NICOLE WARNER SHAHA PA-C (SURGICAL ASSISTANT)
(208) 716-2350
Entity
Organization
Contact information
Practice address
2545 E INTREPID AVE, MESA, AZ 85204-7028
(208) 716-2350
Mailing address
2545 E INTREPID AVE, MESA, AZ 85204-7028
(208) 716-2350
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
—
—
Other
Enumeration date
09/17/2024
Last updated
09/17/2024
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