Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175F00000X | Naturopath | AZ |
NPI | 1083384101 |
---|---|
Provider Name | Dr. Amanda Lauren Ryskowski |
First Address | Peoria, AZ 85383-5554 |
Second Address | Surprise, AZ 85374-3874 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2021 |
Last Update Date | 20/09/2021 |