Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | 348594 | CA |
NPI | 1104076462 |
---|---|
Provider Name | Wendy J Nelson |
First Address | Chula Vista, CA 91913-1800 |
Second Address | La Mesa, CA 91942-3017 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/09/2008 |
Last Update Date | 02/10/2015 |