Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | 8387 | CA |
NPI | 1063523413 |
---|---|
Provider Name | Patricia Mary Brockley |
First Address | Novato, CA 94945-4569 |
Second Address | San Rafael, CA 94901 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 28/09/2015 |