Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 57664 | AZ |
N | 207QG0300X | Family Doctor - Geriatric Medicine | 57664 | AZ |
NPI | 1295115145 |
---|---|
Provider Name | Ndidi Ogechi Ivy Abara |
First Address | Yuma, AZ 85364-7108 |
Second Address | Yuma, AZ 85364-7108 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/06/2015 |
Last Update Date | 25/11/2019 |