Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | 12210A | AZ |
Y | 213ES0000X | Sports Medicine | 12210A | AZ |
NPI | 1386173748 |
---|---|
Provider Name | Aliesje Nichole Thrower |
First Address | Tucson, AZ 85747-5710 |
Second Address | Tucson, AZ 85747 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2017 |
Last Update Date | 08/06/2017 |