Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251H1200X | Hand | 0451 | AZ |
NPI | 1194713453 |
---|---|
Provider Name | Mrs. Ann W Ostrom |
First Address | Phoenix, AZ 85008-6462 |
Second Address | Phoenix, AZ 85013-3420 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/10/2005 |
Last Update Date | 17/12/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
982133 | (05) | AZ |
Q09213 | (02) |