Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | 184455 | MA |
N | 363L00000X | Nurse Practitioner | 518409 | CA |
N | 363LA2200X | Nurse Practitioner - Adult Health | 10258 | CA |
N | 363LC1500X | Nurse Practitioner - Community Health | 10258 | CA |
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 10258 | CA |
N | 363LP2300X | Nurse Practitioner - Primary Care | 10258 | CA |
NPI | 1659483071 |
---|---|
Provider Name | Nancy N Stark |
First Address | Lawrence, KS 66044-2338 |
Second Address | Oakland, CA 94609-1359 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 19/12/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
077834 | SF DPH CHN (01) | CA |
201102900B | (05) | KS |
35515 | UCSF PROVIDER NUMBER (01) | CA |
Q36584 | (02) | CA |