Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175L00000X | Homeopath | 0583389 | CA |
NPI | 1184867087 |
---|---|
Provider Name | Mrs. Joanna Michelle Mckinley |
First Address | Modesto, CA 95350-1158 |
Second Address | Modesto, CA 95350-1158 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/04/2009 |
Last Update Date | 08/04/2009 |