Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 176B00000X | Midwife | LM96 | CA |
NPI | 1073653770 |
---|---|
Provider Name | Mary Alice Earhart |
First Address | Thermal, CA 92274-9231 |
Second Address | Thermal, CA 92274-9231 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/02/2007 |
Last Update Date | 08/07/2007 |