Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LG0600X | Nurse Practitioner - Gerontology | 16053 | CA |
NPI | 1033140884 |
---|---|
Provider Name | Mrs. Marie Joyner Nelsen |
First Address | Ventura, CA 93004-2401 |
Second Address | Oxnard, CA 93036-2692 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/07/2006 |
Last Update Date | 26/02/2020 |