Provider Demographics
NPI:1447849963
Name:DARK SKY ASSIST
Entity type:Organization
Organization Name:DARK SKY ASSIST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FNP
Authorized Official - Prefix:
Authorized Official - First Name:ELISA
Authorized Official - Middle Name:A
Authorized Official - Last Name:VENEZIA
Authorized Official - Suffix:
Authorized Official - Credentials:FNP/RNFA
Authorized Official - Phone:928-310-6333
Mailing Address - Street 1:1475 FOREST VW W
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86305-5118
Mailing Address - Country:US
Mailing Address - Phone:928-310-3333
Mailing Address - Fax:
Practice Address - Street 1:1475 FOREST VW W
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86305-5118
Practice Address - Country:US
Practice Address - Phone:928-310-6333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-11
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty