Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | A110646 | CA |
Y | 213ES0000X | Sports Medicine | A110646 | CA |
NPI | 1073772844 |
---|---|
Provider Name | Julie Ingwerson |
First Address | Sacramento, CA 95817-2307 |
Second Address | Sacramento, CA 95817-2307 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/06/2008 |
Last Update Date | 14/04/2017 |