Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | AT3373 | AZ |
NPI | 1003042961 |
---|---|
Provider Name | Ms. Karla D Wax |
First Address | Phoenix, AZ 85006-2754 |
Second Address | Phoenix, AZ 85006-2754 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/06/2009 |
Last Update Date | 05/06/2009 |