Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LF0000X | Nurse Practitioner - Family Medicine | 95018143 | CA |
N | 363LP0200X | Nurse Practitioner - Pediatrics | 95018143 | CA |
Y | 363LP2300X | Nurse Practitioner - Primary Care | 95018143 | CA |
NPI | 1023784881 |
---|---|
Provider Name | Dr. Nicole Lorraine Brustkern |
First Address | Chula Vista, CA 91913-3630 |
Second Address | La Jolla, CA 92037-7344 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/08/2021 |
Last Update Date | 20/08/2021 |