Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | 20021 | CA |
NPI | 1013202977 |
---|---|
Provider Name | Pamela Rebecca Marsh |
First Address | Clovis, CA 93611-0207 |
Second Address | Madera, CA 93636-8761 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/06/2011 |
Last Update Date | 17/06/2011 |