Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | 540984-13782 | CA |
NPI | 1043376122 |
---|---|
Provider Name | Stacie Bonn Rohrbaugh |
First Address | Encinitas, CA 92024-7707 |
Second Address | San Diego, CA 92134-1098 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/12/2006 |
Last Update Date | 08/07/2007 |