Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2084N0400X | Neurologist | A92656 | CA |
Y | 2084N0402X | Child Neurologist | A92656 | CA |
NPI | 1215092382 |
---|---|
Provider Name | Dr. Courtney Jane Wusthoff |
First Address | Palo Alto, CA 94304-1507 |
Second Address | Palo Alto, CA 94304-1507 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/12/2006 |
Last Update Date | 13/11/2019 |