Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | AP4152 | AZ |
NPI | 1003195025 |
---|---|
Provider Name | Aida E Amado |
First Address | Mesa, AZ 85209-7086 |
Second Address | Mesa, AZ 85209-7086 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/08/2011 |
Last Update Date | 08/08/2011 |