Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251H1200X | Hand | 1587 | AZ |
NPI | 1427046762 |
---|---|
Provider Name | Sally Robison Cass |
First Address | Flagstaff, AZ 86001-4698 |
Second Address | Flagstaff, AZ 86001-4649 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/10/2005 |
Last Update Date | 18/11/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
335217 | (05) | AZ |
S90643 | (02) |