Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | AP1721 | AZ |
NPI | 1013959964 |
---|---|
Provider Name | Mrs. Brenda A. Austin |
First Address | Prescott, AZ 86305-3700 |
Second Address | Prescott, AZ 86305-3700 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/06/2006 |
Last Update Date | 29/04/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1013959964 | INDIVIDUAL (01) | AZ |