Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | RN484689 NP11635 | CA |
N | 363LW0102X | Nurse Practitioner - Women's Health | RN484689 NP11635 | CA |
NPI | 1023158698 |
---|---|
Provider Name | Ms. Joda Herran Weathersby |
First Address | Anaheim, CA 92815-1131 |
Second Address | Los Angeles, CA 90012-2601 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/02/2007 |
Last Update Date | 05/08/2009 |