Individual
LOLA KAN SUE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
500 INDIANA AVE, WINSLOW, AZ 86047-2169
(928) 289-4646
(928) 289-6290
Mailing address
500 INDIANA AVE, WINSLOW, AZ 86047-2169
(928) 289-4646
(928) 289-6290
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
23895
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
413857
—
AZ
Enumeration date
03/07/2007
Last updated
11/01/2007
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