Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | RN152456 | AZ |
NPI | 1003207655 |
---|---|
Provider Name | Veronica Linn |
First Address | Phoenix, AZ 85024-1217 |
Second Address | Federal Way, WA 98003-8300 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/02/2015 |
Last Update Date | 29/10/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
RN152456 | LICENSE (01) | AZ |