Individual
MRS. DORTHEA JEANETTE FINICUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2150 MONTE VISTA, PAULDEN, AZ 96334
(928) 636-0505
Mailing address
PO BOX 98, PAULDEN, AZ 86334-0098
(928) 636-0505
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8A4763
AHCCCS
AZ
Enumeration date
12/11/2006
Last updated
07/08/2007
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