Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | AP3154 | AZ |
NPI | 1013175298 |
---|---|
Provider Name | Ms. Maria Jaeger Thillet |
First Address | Phoenix, AZ 85007-1205 |
Second Address | Scottsdale, AZ 85258-4518 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2008 |
Last Update Date | 27/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
374071 | (05) | AZ |