Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | RL15848 | ND |
NPI | 1003468984 |
---|---|
Provider Name | Jolynn Azure |
First Address | Minot, ND 58701-4207 |
Second Address | Minot, ND 58701-4207 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2019 |
Last Update Date | 11/07/2019 |