Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 95007289 | CA |
N | 363LA2100X | Nurse Practitioner - Acute Care | 95007289 | CA |
N | 363LA2200X | Nurse Practitioner - Adult Health | 95007289 | CA |
N | 363LG0600X | Nurse Practitioner - Gerontology | 95007289 | CA |
NPI | 1073032504 |
---|---|
Provider Name | Mrs. Julia K Vandross |
First Address | Stanford, CA 94305-2200 |
Second Address | Stanford, CA 94305-2200 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/09/2017 |
Last Update Date | 16/09/2021 |