Individual
MRS. CAROLYN WANYAMA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
44880 W PORTABELLO ROAD, MARICOPA, AZ 85139
(520) 494-2626
Mailing address
44880 W PORTABELLO ROAD, MARICOPA, AZ 85139
(480) 374-0486
Taxonomy
Speciality
Code
Description
License number
State
376G00000X
Nursing Home Administrator
Primary
AL10166H
AZ
Other
Enumeration date
05/08/2017
Last updated
05/08/2017
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