Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | 95017197 | CA |
NPI | 1003493024 |
---|---|
Provider Name | Alexia Lynn Pratt |
First Address | Orangevale, CA 95662-4461 |
Second Address | Madera, CA 93636-8762 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/03/2021 |
Last Update Date | 22/04/2021 |