Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | LM122 | AZ |
NPI | 1093954778 |
---|---|
Provider Name | Lucinda Carlson |
First Address | Queen Creek, AZ 85242-9301 |
Second Address | Queen Creek, AZ 85242-9301 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/02/2009 |
Last Update Date | 19/02/2009 |