Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | RN073728 | AZ |
NPI | 1003883273 |
---|---|
Provider Name | Teri Victor |
First Address | Phoenix, AZ 85080-1638 |
Second Address | Surprise, AZ 85378-9021 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/03/2006 |
Last Update Date | 27/08/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
243632 | (05) | AZ |
P96814 | (02) | AZ |