Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | 20553 | CA |
NPI | 1033402300 |
---|---|
Provider Name | Betsy Novotny |
First Address | Monterey, CA 93940-5736 |
Second Address | Monterey, CA 93940-5736 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/05/2011 |
Last Update Date | 19/05/2011 |