Individual
IVONNE LOREN A WADLEIGH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
100 E CORTE RANCHO COLINA, SAHUARITA, AZ 85629-9061
(520) 207-1687
Mailing address
100 E CORTE RANCHO COLINA, SAHUARITA, AZ 85629-9061
(520) 207-1687
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
874986
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
874986
STATE OF AZ PFH LICENSE
AZ
Enumeration date
07/18/2008
Last updated
07/18/2008
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