Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 95005727 | CA |
NPI | 1003352659 |
---|---|
Provider Name | Miss Lindsay Grace Mann |
First Address | El Monte, CA 91731-3600 |
Second Address | El Monte, CA 91731-3600 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/01/2017 |
Last Update Date | 06/01/2017 |