Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | NP 18337 | CA |
Y | 363LA2100X | Nurse Practitioner - Acute Care | NP 18337 | CA |
NPI | 1013220359 |
---|---|
Provider Name | Mary Petrofsky |
First Address | Stanford, CA 94305-5221 |
Second Address | Stanford, CA 94305-5221 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/07/2010 |
Last Update Date | 13/01/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1437292927 | MEDI-CAL (01) | CA |