Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 3872 | AZ |
Y | 103T00000X | Psychologist | 3872 | AZ |
NPI | 1013176304 |
---|---|
Provider Name | Donna S Bender |
First Address | Tucson, AZ 85756-7124 |
Second Address | Tucson, AZ 85724-0001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/06/2008 |
Last Update Date | 15/07/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
337777 | (05) | AZ |