Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | LM189 | AZ |
NPI | 1114324241 |
---|---|
Provider Name | Amy Grace Dufour Smith |
First Address | Phoenix, AZ 85018-4730 |
Second Address | Phoenix, AZ 85012-1263 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/12/2014 |
Last Update Date | 04/12/2014 |