Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | 95013435 | CA |
N | 363LP2300X | Nurse Practitioner - Primary Care | 95013435 | CA |
NPI | 1053949214 |
---|---|
Provider Name | Ms. Gina Louise James |
First Address | Folsom, CA 95630-4614 |
Second Address | Folsom, CA 95630-4614 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/03/2020 |
Last Update Date | 31/03/2020 |