Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | AZ 145 | AZ |
NPI | 1114145661 |
---|---|
Provider Name | Mrs. Judith Ann Melton |
First Address | Phoenix, AZ 85008-4438 |
Second Address | Mesa, AZ 85201-5857 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/04/2007 |
Last Update Date | 22/04/2008 |