Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | 009241 | AZ |
NPI | 1295301901 |
---|---|
Provider Name | Jessica Heffel |
First Address | Scottsdale, AZ 85257-3493 |
Second Address | Tempe, AZ 85284-2800 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/06/2021 |
Last Update Date | 02/06/2021 |