Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207U00000X | Nuclear Medicine Specialist | A69284 | CA |
NPI | 1033297700 |
---|---|
Provider Name | Marie R. Carlisle |
First Address | Oakland, CA 94612-3429 |
Second Address | Sacramento, CA 95825-2115 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A692840 | (05) | CA |
I12144 | (02) |