Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | AP9657 | AZ |
N | 363LG0600X | Nurse Practitioner - Gerontology | AP9657 | AZ |
NPI | 1063951614 |
---|---|
Provider Name | Patricia Mayborne |
First Address | Scottsdale, AZ 85255-6520 |
Second Address | Scottsdale, AZ 85258-4582 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/02/2017 |
Last Update Date | 08/02/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
250048 | (05) | AZ |