Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | RN089032 | AZ |
NPI | 1003857301 |
---|---|
Provider Name | Mary Lynn Miners |
First Address | Tucson, AZ 85718-5999 |
Second Address | Tucson, AZ 85710-3587 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2006 |
Last Update Date | 30/01/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
527202 | (05) | AZ |
P17165 | (02) | AZ |