Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LG0600X | Nurse Practitioner - Gerontology | 12785 | CA |
NPI | 1023179447 |
---|---|
Provider Name | Anna Ignatova |
First Address | San Francisco, CA 94110-1388 |
Second Address | San Francisco, CA 94118-3101 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/12/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
Q05016 | (02) | CA |