Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0214X | Pediatric Pulmonologist | 17428 | AZ |
NPI | 1144399387 |
---|---|
Provider Name | Diane Neddenriep |
First Address | Tucson, AZ 85712-2158 |
Second Address | Tucson, AZ 85712-2158 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/11/2006 |
Last Update Date | 02/05/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
277998 | (05) | AZ |