Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 5064 | AZ |
NPI | 1538373014 |
---|---|
Provider Name | Elizabeth Kronlage |
First Address | Tucson, AZ 85719-5966 |
Second Address | Tucson, AZ 85716-4757 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/05/2007 |
Last Update Date | 04/02/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
348980 | (05) | AZ |