Individual
BAOTRAM THAI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
250 E DUNLAP AVE, PHOENIX, AZ 85020-2825
(238) 160-2943
Mailing address
5461 N 87TH DR, GLENDALE, AZ 85305-2299
Taxonomy
Speciality
Code
Description
License number
State
163WM0705X
Medical-Surgical Registered Nurse
Primary
270826
AZ
Other
Enumeration date
08/23/2024
Last updated
08/23/2024
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