Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | 95009504 | CA |
NPI | 1023594579 |
---|---|
Provider Name | Nathan M Kostiv |
First Address | Carmichael, CA 95608-0306 |
Second Address | Carmichael, CA 95608-0306 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2018 |
Last Update Date | 09/01/2020 |