Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 176B00000X | Midwife | 0001159508 | VA |
Y | 176B00000X | Midwife | AP3538 | AZ |
NPI | 1144550120 |
---|---|
Provider Name | Sandra J Macon |
First Address | Tucson, AZ 85745-2819 |
Second Address | Tucson, AZ 85712-6104 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/01/2010 |
Last Update Date | 13/01/2010 |