Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | RN334340 | CA |
NPI | 1013051796 |
---|---|
Provider Name | Socorro Marie Chisholm |
First Address | Los Angeles, CA 90007-3304 |
Second Address | Los Angeles, CA 90007-3304 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/02/2007 |
Last Update Date | 08/07/2007 |