Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | LM238 | CA |
NPI | 1003053968 |
---|---|
Provider Name | Tanya Elan Bullwinkle |
First Address | Eureka, CA 95503-9570 |
Second Address | Eureka, CA 95503-4892 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/01/2009 |
Last Update Date | 19/12/2012 |