Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0200X | Radiology | DC29184 | CA |
Y | 213ER0200X | Radiology | DC29184 | CA |
NPI | 1568638716 |
---|---|
Provider Name | Mrs. Amy Lynn Fansler |
First Address | Orangevale, CA 95662 |
Second Address | Orangevale, CA 95662-3969 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/05/2008 |
Last Update Date | 07/05/2008 |