Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | 322 | CA |
NPI | 1023399961 |
---|---|
Provider Name | Tari Neill |
First Address | Felton, CA 95018-9338 |
Second Address | Felton, CA 95018-9338 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/09/2011 |
Last Update Date | 08/11/2011 |