Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | 95010516 | CA |
NPI | 1003390519 |
---|---|
Provider Name | Jennifer Le |
First Address | Palm Desert, CA 92260-4401 |
Second Address | Coachella, CA 92236 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2018 |
Last Update Date | 12/12/2018 |