Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | 4204 | AZ |
NPI | 1093082661 |
---|---|
Provider Name | Mrs. Melisa Ann Clayton |
First Address | Tucson, AZ 85704-6928 |
Second Address | Tucson, AZ 85704-6928 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/11/2011 |
Last Update Date | 25/11/2011 |