Registry details
Type
Individual
Primary specialty
Nurse Practitioner, Family
Enumerated
Mar 15, 2019
License(s)
R194825 (MD), 95010923 (CA)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| MAILING | 501 FAIR MEADOWS BLVD | Hagerstown, MD 21740-6780 | |
| LOCATION | 20601 WEST PAOLI LANE | Weimar, CA 95736 | 530-296-4417 |
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