Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 95009685 | CA |
N | 363L00000X | Nurse Practitioner | AP30006664 | WA |
NPI | 1003868316 |
---|---|
Provider Name | Olinda Su Mar |
First Address | Stanford, CA 94305-2200 |
Second Address | Stanford, CA 94305-2200 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/05/2006 |
Last Update Date | 26/10/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0223131 | L&I (01) | WA |
1003868316 | (05) | WA |
Q23497 | (02) | WA |