Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251H1200X | Hand | 1294 | AZ |
NPI | 1780640045 |
---|---|
Provider Name | Peggy Lee Langley |
First Address | Glendale, AZ 85308-4621 |
Second Address | Glendale, AZ 85308-3605 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/04/2006 |
Last Update Date | 23/02/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
852790 | ACCHS (01) | AZ |
Z81210 | MEDICARE (01) | AZ |