Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | 95010148 | CA |
NPI | 1023587516 |
---|---|
Provider Name | Elizabeth Branson |
First Address | Riverside, CA 92505-8561 |
Second Address | Santa Ana, CA 92705-4079 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/11/2018 |
Last Update Date | 14/11/2018 |