Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | 271738 | CA |
NPI | 1043224769 |
---|---|
Provider Name | Mrs. Deborah Kay Hastie |
First Address | Stockton, CA 95207 |
Second Address | Stockton, CA 95207 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2006 |
Last Update Date | 08/07/2007 |