Provider Demographics
NPI:1699252544
Name:GREEN STATES ANESTHESIA PLLC
Entity type:Organization
Organization Name:GREEN STATES ANESTHESIA PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NORA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRADY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-581-2819
Mailing Address - Street 1:3343 E INDIGO BAY CT
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234-1737
Mailing Address - Country:US
Mailing Address - Phone:702-581-2819
Mailing Address - Fax:866-329-8262
Practice Address - Street 1:1220 CARAWAY CT STE 1050
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20774-5338
Practice Address - Country:US
Practice Address - Phone:800-783-8584
Practice Address - Fax:800-783-8584
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-24
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223D0004XDental ProvidersDentistDental AnesthesiologyGroup - Single Specialty