Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | 46677 | AZ |
Y | 207VX0201X | Gynecologic Oncologist | 46677 | AZ |
NPI | 1043229529 |
---|---|
Provider Name | Lyndsay Jean Willmott |
First Address | Tucson, AZ 85718-5877 |
Second Address | Phoenix, AZ 85016-4872 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/08/2006 |
Last Update Date | 08/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
734431 | (05) | AZ |