Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | 16718 | AZ |
NPI | 1063400802 |
---|---|
Provider Name | Katherine A Schuppert |
First Address | Tucson, AZ 85712-2704 |
Second Address | Tucson, AZ 85712-2139 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/10/2005 |
Last Update Date | 22/12/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
285892 01 | (05) | AZ |
D00277 | (02) |