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Individual
MARIETTA FORMOSO LIGHT
Active
Individual
MARIETTA FORMOSO LIGHT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP-C
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
6030
CA
363LW0102X
Women's Health Nurse Practitioner
6030
CA
363LX0001X
Obstetrics & Gynecology Nurse Practitioner
Primary
6030
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
302503
REGISTERED NURSE LIC
CA
01
—
6030
NURSE PRACTITIONER FURN
CA
Enumeration date
12/30/2005
Last updated
10/08/2020
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