Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 481610 | CA |
N | 363LA2200X | Nurse Practitioner - Adult Health | 481610 | CA |
N | 363LC1500X | Nurse Practitioner - Community Health | 481610 | CA |
NPI | 1326001439 |
---|---|
Provider Name | Mercy Egbujor |
First Address | San Jose, CA 95128-2604 |
Second Address | San Jose, CA 95125-1031 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/04/2006 |
Last Update Date | 14/09/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
P87501 | (02) | CA |