Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0401X | Family Doctor - Addiction Medicine | 223620 | AZ |
N | 363LF0000X | Nurse Practitioner - Family Medicine | 223620 | AZ |
NPI | 1386047850 |
---|---|
Provider Name | Emily E Vona |
First Address | Lake Havasu City, AZ 86403-6096 |
Second Address | Lake Havasu City, AZ 86403 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/09/2014 |
Last Update Date | 15/01/2021 |