Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | 95001636 | CA |
NPI | 1003295205 |
---|---|
Provider Name | Lauren Roos |
First Address | Santa Rosa, CA 95407-6802 |
Second Address | Santa Rosa, CA 95407-6802 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/05/2015 |
Last Update Date | 21/05/2015 |