Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LW0102X | Nurse Practitioner - Women's Health | 5249 | CA |
NPI | 1023111226 |
---|---|
Provider Name | Melanie Jenkins Austin |
First Address | San Rafael, CA 94901-4861 |
Second Address | San Rafael, CA 94901-4861 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/09/2006 |
Last Update Date | 20/11/2008 |