Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LW0102X | Nurse Practitioner - Women's Health | NP11072 | CA |
NPI | 1053400978 |
---|---|
Provider Name | Shauna Marioni II |
First Address | Vacaville, CA 95688-9430 |
Second Address | Vacaville, CA 95688-9543 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/10/2006 |
Last Update Date | 08/07/2007 |