Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | AP8225 | AZ |
NPI | 1013374206 |
---|---|
Provider Name | Alayna M Despain |
First Address | Tempe, AZ 85284-3417 |
Second Address | Tempe, AZ 85284-3417 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/01/2016 |
Last Update Date | 04/04/2017 |