Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 588995 | CA |
N | 363LA2200X | Nurse Practitioner - Adult Health | 588995 | CA |
N | 363LG0600X | Nurse Practitioner - Gerontology | 588995 | CA |
NPI | 1083808182 |
---|---|
Provider Name | Mr. Marshall John Saipher |
First Address | Manteca, CA 95336-8341 |
Second Address | Stockton, CA 95215-9663 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2007 |
Last Update Date | 23/07/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
QO9315 | (02) |