Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | LM300 | CA |
NPI | 1053602052 |
---|---|
Provider Name | Jessica Ellen Mairs |
First Address | Grass Valley, CA 95945-4509 |
Second Address | Grass Valley, CA 95945-4509 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/04/2011 |
Last Update Date | 25/04/2011 |