Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | 483911 | CA |
N | 363LW0102X | Nurse Practitioner - Women's Health | NP CERTIFICATE 8724 | CA |
NPI | 1053407791 |
---|---|
Provider Name | Ms. Leta Marilyn Rosenfield |
First Address | Lincoln, CA 95648 |
Second Address | Roseville, CA 95661 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
P18799 | (02) | CA |