Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | CPO04121 | CA |
N | 222Z00000X | Podiatrist | CPO04121 | CA |
Y | 224P00000X | Prosthetist | CPO04121 | CA |
NPI | 1376029512 |
---|---|
Provider Name | Miss Natalie Elise Wilson |
First Address | Glendale, CA 91206-4741 |
Second Address | Glendale, CA 91206-4741 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2018 |
Last Update Date | 11/07/2018 |