Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RE0101X | Endocrinologist (Diabetes Doctor) | A25795 | CA |
NPI | 1063428001 |
---|---|
Provider Name | Dr. Nancy J Bohannon |
First Address | San Francisco, CA 94110-4415 |
Second Address | San Francisco, CA 94110-4415 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/07/2006 |
Last Update Date | 18/01/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A25795 | STATE LICENSE (01) | CA |
F03942 | (02) | CA |