Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | AP9710 | AZ |
NPI | 1033533476 |
---|---|
Provider Name | Mrs. Emily T Roth |
First Address | Nogales, AZ 85621-1063 |
Second Address | Nogales, AZ 85621-1063 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/02/2014 |
Last Update Date | 05/09/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
223392 | (05) | AZ |