Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | 95001627 | CA |
N | 363LC0200X | Nurse Practitioner - Critical Care Medicine | 95001627 | CA |
NPI | 1134525512 |
---|---|
Provider Name | Jane Lee |
First Address | San Francisco, CA 94143-2203 |
Second Address | San Francisco, CA 94143-2204 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/11/2014 |
Last Update Date | 12/11/2014 |