Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 18961 | CA |
NPI | 1003043753 |
---|---|
Provider Name | Amy Melissa Shapiro |
First Address | Roseville, CA 95661-3844 |
Second Address | Carmichael, CA 95608-0306 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/06/2009 |
Last Update Date | 19/06/2009 |