Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | 95019613 | CA |
NPI | 1033870985 |
---|---|
Provider Name | Danielle Michelle Blonstein |
First Address | Sacramento, CA 95816-4767 |
Second Address | Roseville, CA 95678-5796 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/01/2022 |
Last Update Date | 03/01/2022 |