Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | 95015887 | CA |
NPI | 1023613056 |
---|---|
Provider Name | Jessica Cotter Hainje |
First Address | Marina Del Rey, CA 90292-7072 |
Second Address | Santa Monica, CA 90404-1249 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/11/2020 |
Last Update Date | 30/11/2020 |