Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | 5365 | AZ |
NPI | 1164424156 |
---|---|
Provider Name | Diana Lynn Snook |
First Address | Willcox, AZ 85643-2127 |
Second Address | Willcox, AZ 85643-2127 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/08/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U68523 | (02) | AZ |