Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | 079 | AZ |
NPI | 1033536669 |
---|---|
Provider Name | Cindy Packard |
First Address | Gilbert, AZ 85234-4019 |
Second Address | Gilbert, AZ 85234-4019 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/03/2014 |
Last Update Date | 20/03/2014 |