Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YS0200X | School Counselor | 572918 | AZ |
NPI | 1043355860 |
---|---|
Provider Name | Mrs. Kelly Anne Magura |
First Address | Phoenix, AZ 85019-3206 |
Second Address | Phoenix, AZ 85019-3206 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/02/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
572918 | AHCCCS (01) | AZ |