Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175L00000X | Homeopath | 3508 | AZ |
NPI | 1609994896 |
---|---|
Provider Name | Ms. Emily Rose Jagodzinski |
First Address | Surprise, AZ 85374-9340 |
Second Address | Surprise, AZ 85378-9340 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/03/2007 |
Last Update Date | 30/04/2018 |