Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111NI0013X | Independent Medical Examiner | 5882 | AZ |
Y | 363LF0000X | Nurse Practitioner - Family Medicine | AP7572 | AZ |
NPI | 1194968693 |
---|---|
Provider Name | Caron Constance Pedersen |
First Address | Chandler, AZ 85224-7632 |
Second Address | Chandler, AZ 85224-7632 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/04/2009 |
Last Update Date | 30/11/2016 |