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Individual

MRS. LEIGHANNE GENTILE ERVIEN

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
294 W CARLOS AVE, HOLBROOK, AZ 86025-1846
(928) 524-2123
Mailing address
2900 MOUNTAIN DR, WINSLOW, AZ 86047-6956
(928) 289-0310

Taxonomy

Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
1395
AZ

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
928393
AZ
Enumeration date
12/01/2006
Last updated
07/08/2007
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