Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LA2100X | Nurse Practitioner - Acute Care | 95015622 | CA |
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | 95015622 | CA |
N | 363LF0000X | Nurse Practitioner - Family Medicine | 95015622 | CA |
NPI | 1366061285 |
---|---|
Provider Name | Dewayne Lee Cecil |
First Address | Sacramento, CA 95825-2296 |
Second Address | Sacramento, CA 95816-6510 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/04/2020 |
Last Update Date | 07/07/2021 |