Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | 20965 | CA |
NPI | 1225315963 |
---|---|
Provider Name | Ms. Annette Dixie Wassell |
First Address | Fresno, CA 93650-3844 |
Second Address | Fresno, CA 93721-1324 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/11/2011 |
Last Update Date | 09/11/2011 |