Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | 95002902 | CA |
NPI | 1326417221 |
---|---|
Provider Name | Kacy Minot |
First Address | San Francisco, CA 94158-2351 |
Second Address | San Francisco, CA 94158-2351 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/09/2015 |
Last Update Date | 21/09/2015 |