Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | 0373 | CA |
NPI | 1053732347 |
---|---|
Provider Name | Lesley Nelson |
First Address | Davis, CA 95616-2282 |
Second Address | Davis, CA 95616-2282 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/01/2014 |
Last Update Date | 03/01/2014 |