Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | 681647 | CA |
NPI | 1073917464 |
---|---|
Provider Name | Mara Wendel |
First Address | San Diego, CA 92108-3538 |
Second Address | San Diego, CA 92114-3644 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/10/2014 |
Last Update Date | 15/10/2014 |