Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | 308819 | CA |
NPI | 1235250895 |
---|---|
Provider Name | Ms. Doris Elaine Stenson |
First Address | Modesto, CA 95354-1408 |
Second Address | Modesto, CA 95350-4405 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/04/2007 |
Last Update Date | 08/07/2007 |