Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | AP1045 | AZ |
NPI | 1083766422 |
---|---|
Provider Name | Cynthia Faye Hale |
First Address | Yuma, AZ 85367-7886 |
Second Address | Yuma, AZ 85367-7886 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/01/2007 |
Last Update Date | 26/08/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
771677 | AHCCCS (01) | AZ |