Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | 2130 | AZ |
NPI | 1063469781 |
---|---|
Provider Name | Karin Vannieuwenhuizen |
First Address | Prescott, AZ 86301-5350 |
Second Address | Prescott, AZ 86301-1641 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/05/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
456104 | (05) | AZ |
P08504 | (02) | AZ |