Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LG0600X | Nurse Practitioner - Gerontology | 229807 | AZ |
NPI | 1013568542 |
---|---|
Provider Name | Lorraine Y Yentzer |
First Address | Tucson, AZ 85742-4817 |
Second Address | Tucson, AZ 85712-2874 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/09/2019 |
Last Update Date | 25/09/2019 |