Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife |
NPI | 1154096501 |
---|---|
Provider Name | Tamara Juel Nelson |
First Address | Santa Cruz, CA 95062-2831 |
Second Address | Santa Cruz, CA 95062-2831 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2021 |
Last Update Date | 09/08/2021 |