Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | 21775 | CA |
NPI | 1063771806 |
---|---|
Provider Name | Mrs. Michelle Mckenney Buenrostro |
First Address | Los Altos, CA 94022-1408 |
Second Address | Redwood City, CA 94062-1433 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/05/2012 |
Last Update Date | 11/06/2020 |