Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC1500X | Nurse Practitioner - Community Health | 95001895 | CA |
NPI | 1790176543 |
---|---|
Provider Name | Diane De Vos-Schmidt |
First Address | Santa Maria, CA 93454-6917 |
Second Address | San Luis Obispo, CA 93401-7068 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/02/2015 |
Last Update Date | 12/04/2016 |