Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | AP 1768 | AZ |
NPI | 1205835337 |
---|---|
Provider Name | Jean Audrey Nelson |
First Address | Scottsdale, AZ 85251-6900 |
Second Address | Scottsdale, AZ 85251-6900 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2005 |
Last Update Date | 18/12/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
873415 | (05) | AZ |
Q16584 | (02) |