# NPI 1639604978

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- **Entity:** Individual
- **Status:** Inactive

## Provider details

- **NPI number:** 1639604978

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363L00000X | Nurse Practitioner | 95016497 | CA | Yes |
| 363LA2100X | Acute Care Nurse Practitioner | 53-77629 | KS | — |

## Other

- **Enumeration date:** —
- **Last updated:** —