Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 13015 | CA |
NPI | 1003186362 |
---|---|
Provider Name | Leslie M Hutton |
First Address | Santa Maria, CA 93454-4619 |
Second Address | Santa Maria, CA 93454-4619 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/01/2012 |
Last Update Date | 04/01/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
13015 | NP LICENSE (01) | CA |