Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LG0600X | Nurse Practitioner - Gerontology | NP95011402 | CA |
NPI | 1023579505 |
---|---|
Provider Name | Melissa D. Gerardo |
First Address | Visalia, CA 93277-7287 |
Second Address | Visalia, CA 93277-7287 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/03/2019 |
Last Update Date | 27/03/2019 |