Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | 95016896 | CA |
NPI | 1043898851 |
---|---|
Provider Name | La'shonda Mechel Sharble |
First Address | Rocklin, CA 95765-5675 |
Second Address | San Jose, CA 95123-3667 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/04/2021 |
Last Update Date | 21/01/2022 |