Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LG0600X | Nurse Practitioner - Gerontology | 10811 | CA |
NPI | 1023031655 |
---|---|
Provider Name | Miss Madeline Tam Chow |
First Address | Berkeley, CA 94710-1717 |
Second Address | Berkeley, CA 94710-1717 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/07/2006 |
Last Update Date | 05/08/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
MT0629874 | DEA (01) | CA |
NP0108110 | (05) | CA |
P60439 | (02) | CA |