Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | 20A7319 | CA |
NPI | 1033227715 |
---|---|
Provider Name | Sandra Jean Shetzline |
First Address | Murphys, CA 95247-9705 |
Second Address | Arnold, CA 95223 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/08/2006 |
Last Update Date | 08/07/2007 |