Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | 219386 | AZ |
NPI | 1013481670 |
---|---|
Provider Name | Saralyn Heddleston |
First Address | Phoenix, AZ 85012-2716 |
Second Address | Chandler, AZ 85224 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/01/2019 |
Last Update Date | 22/07/2019 |