Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174V00000X | Clinical Ethicist | AZ |
NPI | 1669876652 |
---|---|
Provider Name | Azeila Ticka Davis |
First Address | Phoenix, AZ 85041-3334 |
Second Address | Phoenix, AZ 85041-3334 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/10/2014 |
Last Update Date | 20/10/2014 |