Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | 534431 | CA |
NPI | 1003904418 |
---|---|
Provider Name | Mrs. Pantea Nosrat Dunn |
First Address | Sacramento, CA 95815-4314 |
Second Address | Roseville, CA 95661-3047 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/10/2006 |
Last Update Date | 19/10/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
534431 | PNP LICENSE (01) | CA |