Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | 0157 | AZ |
NPI | 1073752119 |
---|---|
Provider Name | Mrs. Connie L. Canada |
First Address | Litchfield Park, AZ 85340-3306 |
Second Address | Litchfield Park, AZ 85340-3306 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/02/2009 |
Last Update Date | 12/02/2009 |