Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 20A8801 | CA |
NPI | 1649470485 |
---|---|
Provider Name | Stephanie Ruth Nani |
First Address | Grass Valley, CA 95945-9529 |
Second Address | Grass Valley, CA 95945-9529 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2007 |
Last Update Date | 17/06/2011 |