Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | 352429 | CA |
NPI | 1073592416 |
---|---|
Provider Name | Roxanne Cara Stiles-Donnelly |
First Address | Antioch, CA 94509-4006 |
Second Address | Antioch, CA 94509-4006 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/01/2006 |
Last Update Date | 03/01/2022 |