Individual
AMANDA TOOTSIE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
HWY 264 MP388, POLACCA, AZ 86042
(928) 737-6000
Mailing address
HWY 264 MP388, POLACCA, AZ 86042
Taxonomy
Speciality
Code
Description
License number
State
374700000X
Technician
Primary
901373
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
020529
—
AZ
Enumeration date
11/25/2015
Last updated
11/25/2015
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