Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | 1905 | CA |
NPI | 1104136373 |
---|---|
Provider Name | Eveline June Venable |
First Address | San Pablo, CA 94806-4552 |
Second Address | Santa Rosa, CA 95405-5239 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/10/2010 |
Last Update Date | 11/02/2022 |