Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YP0228X | Pediatric Otolaryngology | 56854 | AZ |
N | 208200000X | Surgeon | R72569 | AZ |
N | 208600000X | Surgeon | R72569 | AZ |
NPI | 1104106814 |
---|---|
Provider Name | Dr. Erynne Azalea Faucett |
First Address | Phoenix, AZ 85018-2327 |
Second Address | Phoenix, AZ 85016 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/08/2011 |
Last Update Date | 16/08/2018 |