Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 125072686 | IL |
N | 2080P0203X | Pediatric Critical Care Doctor | 009100 | AZ |
NPI | 1053804526 |
---|---|
Provider Name | Grace Erin Rovner |
First Address | Scottsdale, AZ 85250-6100 |
Second Address | Phoenix, AZ 85016-7710 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/06/2018 |
Last Update Date | 14/06/2021 |