Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | 82242 | AZ |
NPI | 1033135744 |
---|---|
Provider Name | Renee O'sullivan |
First Address | Phoenix, AZ 85013-3420 |
Second Address | Phoenix, AZ 85013-3420 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/07/2006 |
Last Update Date | 25/04/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
483892 | (05) | AZ |