Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | NP 20746 | CA |
NPI | 1043464019 |
---|---|
Provider Name | Sunah Song |
First Address | Redlands, CA 92373-7762 |
Second Address | Redlands, CA 92373 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/11/2008 |
Last Update Date | 23/05/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
NP 20746 | CALIFORNIA BOARD OF NURSING (01) | CA |
RN 635805 | CALIFORNIA BOARD OF NURSING (01) | CA |