Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175F00000X | Naturopath | 18-1733 | AZ |
NPI | 1003390105 |
---|---|
Provider Name | Samantha Lee Randahl |
First Address | Mesa, AZ 85209-3326 |
Second Address | Mesa, AZ 85209-3326 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/09/2018 |
Last Update Date | 24/09/2018 |