Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | AP3794 | AZ |
NPI | 1003116633 |
---|---|
Provider Name | Emily Snavely De La Rosa |
First Address | Tucson, AZ 85711-1827 |
Second Address | Tucson, AZ 85711-1827 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/10/2010 |
Last Update Date | 05/06/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
866815 | (05) | AZ |