Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | 238728 | AZ |
NPI | 1083221824 |
---|---|
Provider Name | Kelly Katherine Hosner |
First Address | Chandler, AZ 85246-6730 |
Second Address | Phoenix, AZ 85037-3374 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/09/2020 |
Last Update Date | 25/09/2020 |