Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2080P0207X | Pediatric Hematology-Oncologist | 44137 | MN |
Y | 2080P0207X | Pediatric Hematology-Oncologist | 54572 | AZ |
NPI | 1184696189 |
---|---|
Provider Name | Dr. Cynthia Wetmore |
First Address | Phoenix, AZ 85018-2327 |
Second Address | Phoenix, AZ 85016-7710 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/02/2006 |
Last Update Date | 30/01/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
452400400 | (05) | MN |
H37739 | (02) |