Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | H006901 | AZ |
NPI | 1003490897 |
---|---|
Provider Name | Gail Kathleen Phelps |
First Address | Camp Verde, AZ 86322-1541 |
Second Address | Cottonwood, AZ 86326-3693 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/05/2021 |
Last Update Date | 08/05/2021 |