Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 175L00000X | Homeopath | 0160 | AZ |
Y | 207V00000X | Obstetrician & Gynecologist | 20742 | AZ |
NPI | 1275678872 |
---|---|
Provider Name | Rebecca Lee Wilks |
First Address | Glendale, AZ 85308 |
Second Address | Glendale, AZ 85308 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/02/2007 |
Last Update Date | 21/12/2009 |