Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | R70694 | AZ |
Y | 2080P0216X | Pediatric Rheumatologist | 47754 | AZ |
NPI | 1487980629 |
---|---|
Provider Name | Dr. Elisa C Wershba |
First Address | Phoenix, AZ 85018-2327 |
Second Address | Phoenix, AZ 85006-1462 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/10/2009 |
Last Update Date | 04/04/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
806497 | (05) | AZ |