Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LF0000X | Nurse Practitioner - Family Medicine | AP2233 | AZ |
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | AP2233 | AZ |
NPI | 1023037710 |
---|---|
Provider Name | Miss Audrey Corsberg Elliott |
First Address | Phoenix, AZ 85012-2647 |
Second Address | Phoenix, AZ 85008-2410 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2006 |
Last Update Date | 14/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
123842 | (05) | AZ |