Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | AP7841 | AZ |
NPI | 1043695018 |
---|---|
Provider Name | Sarah Christine Ontiveros |
First Address | Phoenix, AZ 85012-3100 |
Second Address | Glendale, AZ 85306-4660 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2015 |
Last Update Date | 21/02/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
045154 | (05) | AZ |