Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | AP5159 | AZ |
NPI | 1003242314 |
---|---|
Provider Name | Mr. Christopher Ian Earle |
First Address | Tempe, AZ 85281-2964 |
Second Address | Tempe, AZ 85281-2964 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/09/2013 |
Last Update Date | 31/07/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
848051 | (05) | AZ |