Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | 95015805 | CA |
NPI | 1023619442 |
---|---|
Provider Name | Dolores Josephine Meehan |
First Address | San Francisco, CA 94131-2933 |
Second Address | Campbell, CA 95008-7800 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/11/2020 |
Last Update Date | 03/11/2020 |