Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175L00000X | Homeopath | AZ |
NPI | 1164666129 |
---|---|
Provider Name | Bonnie M Phelps |
First Address | Tucson, AZ 85716-4449 |
Second Address | Tucson, AZ 85716-4449 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/04/2009 |
Last Update Date | 21/04/2009 |