Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YS0200X | School Counselor |
NPI | 1255549762 |
---|---|
Provider Name | Ms. Pamela Anderson |
First Address | Tucson, AZ 85730-5759 |
Second Address | Sierra Vista, AZ 85635-4878 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/05/2007 |
Last Update Date | 08/07/2007 |