Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LG0600X | Nurse Practitioner - Gerontology | 19552 | CA |
NPI | 1033440425 |
---|---|
Provider Name | Miss Laura Elizabeth Mcvay |
First Address | Los Angeles, CA 90033-1029 |
Second Address | Los Angeles, CA 90033-1029 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/01/2010 |
Last Update Date | 26/01/2010 |