Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LN0000X | Nurse Practitioner - Neonatal | 077819 | AZ |
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | 077819 | AZ |
NPI | 1144554569 |
---|---|
Provider Name | Lori Jean Fields |
First Address | Mesa, AZ 85202-4707 |
Second Address | Mesa, AZ 85202-4707 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/10/2009 |
Last Update Date | 01/10/2009 |