Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LG0600X | Nurse Practitioner - Gerontology | 455229 | CA |
NPI | 1013136423 |
---|---|
Provider Name | Julie Dutton |
First Address | Cerritos, CA 90703-9329 |
Second Address | San Jose, CA 95130-1026 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/04/2007 |
Last Update Date | 30/08/2019 |