Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175F00000X | Naturopath |
NPI | 1063182517 |
---|---|
Provider Name | Alyssa Taylor Cooper |
First Address | Phoenix, AZ 85018-3589 |
Second Address | Phoenix, AZ 85018-3589 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/09/2021 |
Last Update Date | 16/09/2021 |