Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LW0102X | Nurse Practitioner - Women's Health | 95005404 | CA |
NPI | 1063955011 |
---|---|
Provider Name | Kathleen Dolan Emerson Emerdello |
First Address | San Jose, CA 95126-2203 |
Second Address | Redwood City, CA 94061-4003 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/11/2016 |
Last Update Date | 28/04/2020 |