Individual
MRS. SALLY JOAN VANDE BERG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
16323 N SOTOL AVE, TUCSON, AZ 85739-8966
(520) 603-0027
Mailing address
16323 N SOTOL AVE, TUCSON, AZ 85739-8966
(520) 603-0027
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
LP032723
AZ
Other
Enumeration date
05/07/2009
Last updated
05/07/2009
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