Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | AG10200170 | CA |
NPI | 1033712435 |
---|---|
Provider Name | Ms. Shavon Monique Weatherspoon |
First Address | Compton, CA 90220-1608 |
Second Address | Compton, CA 90220-1608 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/11/2020 |
Last Update Date | 18/11/2020 |