Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | AP4619 | AZ |
NPI | 1003126244 |
---|---|
Provider Name | Michele A Riep |
First Address | Phoenix, AZ 85012-2902 |
Second Address | Phoenix, AZ 85012-2902 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/10/2010 |
Last Update Date | 24/07/2015 |