Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | AP2248 | AZ |
NPI | 1013289701 |
---|---|
Provider Name | Jo Ann Owen Gott |
First Address | Phoenix, AZ 85017-3030 |
Second Address | Chandler, AZ 85224-4287 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/01/2012 |
Last Update Date | 27/01/2012 |