Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | 104646599 | CA |
NPI | 1083260053 |
---|---|
Provider Name | Shanel Loren Alvarado Stadheim |
First Address | Torrance, CA 90504-5513 |
Second Address | Ventura, CA 93003-1651 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/08/2019 |
Last Update Date | 11/06/2020 |