Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | MD433585 | PA |
Y | 207ND0101X | MOHS-Micrographic Surgeon | 48678 | AZ |
NPI | 1174729966 |
---|---|
Provider Name | Dr. Kristina Paley |
First Address | Flagstaff, AZ 86001-1383 |
Second Address | Cottonwood, AZ 86326 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2007 |
Last Update Date | 22/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
PA2040711 | HIGHMARK BCBS (01) | PA |