Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | RN584608 NP14550 | CA |
NPI | 1003944539 |
---|---|
Provider Name | Jessica B. Vetter |
First Address | Berkeley, CA 94720-4301 |
Second Address | Berkeley, CA 94720-4301 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/02/2007 |
Last Update Date | 10/07/2007 |