Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LG0600X | Nurse Practitioner - Gerontology | 4704148100 | MI |
NPI | 1073866950 |
---|---|
Provider Name | Rhonda Beth Dean |
First Address | Scottsdale, AZ 85258-5172 |
Second Address | Scottsdale, AZ 85258-5172 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/10/2012 |
Last Update Date | 17/10/2012 |