Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC1500X | Nurse Practitioner - Community Health | 5458NP | CA |
NPI | 1730392184 |
---|---|
Provider Name | Gwendolyn P. Eymann |
First Address | Grass Valley, CA 95945-5719 |
Second Address | Grass Valley, CA 95945-5719 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/05/2007 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
HSP401050F | (05) | CA |