Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | 95014203 | CA |
NPI | 1093338873 |
---|---|
Provider Name | Miss Courtney M Wilmot |
First Address | Santa Ana, CA 92705-2951 |
Second Address | Sacramento, CA 95814-3503 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/05/2020 |
Last Update Date | 23/06/2020 |