Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2080P0203X | Pediatric Critical Care Doctor | 2005013032 | MO |
Y | 2080P0203X | Pediatric Critical Care Doctor | 36135 | AZ |
NPI | 1043237548 |
---|---|
Provider Name | Dr. Karen Renee Underwood |
First Address | Scottsdale, AZ 85259-3791 |
Second Address | Scottsdale, AZ 85259-3791 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2006 |
Last Update Date | 25/01/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
198533 | MO-BLUE SHIELD (01) |