Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 847 | AZ |
Y | 222Z00000X | Podiatrist | 847 | AZ |
N | 213ES0103X | Foot & Ankle Surgery | 847 | AZ |
NPI | 1073933826 |
---|---|
Provider Name | Evelyn Heigh-Rosen |
First Address | Glendale, AZ 85306-4652 |
Second Address | Glendale, AZ 85306-4636 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/04/2014 |
Last Update Date | 30/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
NA | N/A (01) |