Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 4044 | AZ |
NPI | 1245441716 |
---|---|
Provider Name | Kristin Schad Nelson |
First Address | Tempe, AZ 85281-5652 |
Second Address | Tempe, AZ 85281-5652 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/05/2007 |
Last Update Date | 20/11/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
227443 | (05) | AZ |