Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | 59853 | AZ |
NPI | 1124414834 |
---|---|
Provider Name | Rachel Eliason |
First Address | Phoenix, AZ 85013-4247 |
Second Address | Phoenix, AZ 85013-4247 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/04/2015 |
Last Update Date | 02/06/2020 |