Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156F00000X | Technician/Technologist | 5401 | CA |
NPI | 1215574629 |
---|---|
Provider Name | Blythe Lucy Ann Lehmann |
First Address | Roseville, CA 95678-2767 |
Second Address | Roseville, CA 95678-2767 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/12/2019 |
Last Update Date | 04/12/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
81-3288524 | KAISER (01) | CA |