Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | 2030 |
NPI | 1083956593 |
---|---|
Provider Name | Simone Lance |
First Address | Davis, CA 95617-1260 |
Second Address | Davis, CA 95616-9701 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/03/2013 |
Last Update Date | 22/03/2013 |