Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LC1500X | Nurse Practitioner - Community Health | AP4512 | AZ |
Y | 363LP2300X | Nurse Practitioner - Primary Care | AP4512 | AZ |
NPI | 1174633051 |
---|---|
Provider Name | Charity Marie Correa |
First Address | Scottsdale, AZ 85262-3909 |
Second Address | Phoenix, AZ 85033-5700 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2006 |
Last Update Date | 10/01/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
763934 | (05) | AZ |