Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | 95011098 | CA |
NPI | 1407315815 |
---|---|
Provider Name | Chelsea Sidhu |
First Address | Rancho Cordova, CA 95670-7956 |
Second Address | Stockton, CA 95219-2354 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/03/2019 |
Last Update Date | 19/09/2019 |