Virginia Prendergast LLC

Primary specialty

Adult Health Nurse PractitionerTaxonomy code 363LA2200X

License

RN039088 Issued in AZ

Legal business name

VIRGINIA PRENDERGAST LLC

Practice address

1424 E Marshall Ave
Phoenix, AZ 85014-2358

Phone

(480) 220-4688

Fax

(602) 406-4969

NPI assigned

Aug 4, 2015

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Virginia Prendergast

Title

Director

Phone

(480) 220-4688

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1438646400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1438646400000",
    "number": "1295111987",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1424 E MARSHALL AVE",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850142358",
            "telephone_number": "480-220-4688",
            "fax_number": "602-406-4969"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1424 E MARSHALL AVE",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850142358",
            "telephone_number": "480-220-4688",
            "fax_number": "602-406-4969"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VIRGINIA PRENDERGAST LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-08-04",
        "last_updated": "2015-08-04",
        "status": "A",
        "authorized_official_last_name": "PRENDERGAST",
        "authorized_official_first_name": "VIRGINIA",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "480-220-4688"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "AZ",
            "license": "RN039088",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Luke Anton Vires, COTA
• David E Virgil, M.D.
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• Lizette T. Virissimo
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• Adult Health Nurse Practitioner in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• Adult Health Nurse Practitioner in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.