Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | 19935 | CA |
NPI | 1083923981 |
---|---|
Provider Name | Mrs. Amy Lenea Renfro |
First Address | Modesto, CA 95350-4405 |
Second Address | Modesto, CA 95350-4405 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/09/2010 |
Last Update Date | 09/04/2019 |