Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | 95011480 | CA |
NPI | 1023608304 |
---|---|
Provider Name | Dr. Yasmine Fathima Perdue |
First Address | Newark, CA 94560-5301 |
Second Address | Newark, CA 94560-5301 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/01/2021 |
Last Update Date | 22/11/2021 |