Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175F00000X | Naturopath | 16-1565 | AZ |
NPI | 1114476074 |
---|---|
Provider Name | Brandi Moore |
First Address | Scottsdale, AZ 85254-1528 |
Second Address | Scottsdale, AZ 85254 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2016 |
Last Update Date | 14/10/2019 |