Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XP3100X | Pediatric Orthopaedic Surgeon | 49382 | AZ |
NPI | 1750554747 |
---|---|
Provider Name | Emily Margaret Andrisevic |
First Address | Scottsdale, AZ 85254-7651 |
Second Address | Minneapolis, MN 55454-1404 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/04/2008 |
Last Update Date | 06/02/2017 |