Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | D020738 | AZ |
NPI | 1104239508 |
---|---|
Provider Name | Irma Irene Paulley |
First Address | Ashburn, VA 20147 |
Second Address | Tucson, AZ 85734 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/06/2014 |
Last Update Date | 04/06/2014 |