Individual
VERA ELLEN SUPPO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
554 S BELLVIEW, MESA, AZ 85204-2504
(480) 649-1141
Mailing address
18615 N CELIS ST, MARICOPA, AZ 85238-5179
(520) 208-6121
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
RN05067
AZ
Other
Enumeration date
03/23/2009
Last updated
03/23/2009
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