Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC1500X | Nurse Practitioner - Community Health | NP7766 | CA |
NPI | 1205966579 |
---|---|
Provider Name | Judy A Hart |
First Address | Yucaipa, CA 92399-9405 |
Second Address | San Bernardino, CA 92408-0118 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/03/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
164735 | RN LICENSE (01) | CA |
NP7766 | NP LICENSE (01) | CA |