Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 95001115 | CA |
N | 363LF0000X | Nurse Practitioner - Family Medicine | 95036180 | CA |
NPI | 1003186883 |
---|---|
Provider Name | Joanna Kumar |
First Address | Arcata, CA 95521-6249 |
Second Address | Crescent City, CA 95531-8160 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/01/2012 |
Last Update Date | 07/03/2017 |