Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175F00000X | Naturopath | 19-1797 | AZ |
NPI | 1003458290 |
---|---|
Provider Name | Alexxa Wirth |
First Address | Glendale, AZ 85308-6738 |
Second Address | Phoenix, AZ 85013-1398 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/10/2019 |
Last Update Date | 09/10/2019 |