| NPI | 1801162854 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ED MATROSE Office Manager 623-362-1818 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: AZ 33560) |
| Additional Taxonomies | 363LP0200X Nurse Practitioner, Pediatrics (Licence: AZ AP3855) |
| 363LP0200X Nurse Practitioner, Pediatrics (Licence: AZ AP4013) | |
| Enumeration Date | 2012-03-23 |
| Last Update Date | 2012-03-23 |