Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | 30265 | AZ |
N | 208000000X | Pediatrician | 30265 | AZ |
NPI | 1093700684 |
---|---|
Provider Name | Heather Ruth Cassell |
First Address | Tucson, AZ 85716-2742 |
Second Address | Tucson, AZ 85716-2742 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2005 |
Last Update Date | 29/10/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
431374 | (05) | AZ |
VAD000 | (02) |