Organization
PHYSICIAN ASSISTANT - SURGICAL ASSIST, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. NICOLE VINCELETTE PA (PHYSICIAN ASSISTANT)
(480) 215-3035
Entity
Organization
Contact information
Practice address
4980 S ALMA SCHOOL RD, A2-130, CHANDLER, AZ 85248-5545
(480) 215-3035
Mailing address
4980 S ALMA SCHOOL RD, A2-130, CHANDLER, AZ 85248-5545
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
2841
AZ
Other
Enumeration date
12/22/2011
Last updated
12/22/2011
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