Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | AP7285 | AZ |
NPI | 1043610355 |
---|---|
Provider Name | Miss Laura Margaret Duke |
First Address | Glendale, AZ 85301-1321 |
Second Address | Glendale, AZ 85301-1321 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/08/2014 |
Last Update Date | 24/09/2014 |