Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251H1200X | Hand | 3854 | AZ |
NPI | 1730257163 |
---|---|
Provider Name | Wanda B. Barth-Lindblom |
First Address | Phoenix, AZ 85008-6462 |
Second Address | Glendale, AZ 85306-4641 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/12/2006 |
Last Update Date | 11/12/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
163910 | (05) | AZ |