Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LW0102X | Nurse Practitioner - Women's Health | PENDING | CA |
NPI | 1053981316 |
---|---|
Provider Name | Erica Sadie Keamy |
First Address | Santa Rosa, CA 95403-2149 |
Second Address | Santa Rosa, CA 95403-2149 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2021 |
Last Update Date | 06/07/2021 |