Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | AP3755 | AZ |
NPI | 1033428255 |
---|---|
Provider Name | Kelly Bilof |
First Address | Mesa, AZ 85202-4768 |
Second Address | Mesa, AZ 85202-4768 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/10/2010 |
Last Update Date | 05/06/2012 |