Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175F00000X | Naturopath | 01-660 | AZ |
NPI | 1114119468 |
---|---|
Provider Name | Dr. Amy Lynn O'hara |
First Address | Mesa, AZ 85206-4412 |
Second Address | Mesa, AZ 85206-4412 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/08/2007 |
Last Update Date | 10/08/2007 |