Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | 4436 | AZ |
NPI | 1285931659 |
---|---|
Provider Name | Dr. Kari Vernon |
First Address | Sandpoint, ID 83864-8349 |
Second Address | Phoenix, AZ 85050-3202 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/02/2011 |
Last Update Date | 22/02/2011 |