Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | 239555 | AZ |
NPI | 1033739081 |
---|---|
Provider Name | Anthony Populo |
First Address | Phoenix, AZ 85015-5533 |
Second Address | Phoenix, AZ 85015-5533 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/04/2020 |
Last Update Date | 20/04/2020 |