Individual
LAURENSIA HERMY WIDYASTAMI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AGNP-BC
Contact information
Practice address
450 STANYAN ST, SAN FRANCISCO, CA 94117-1019
(415) 680-4135
Mailing address
61A SUSSEX ST, SAN FRANCISCO, CA 94131-3011
(626) 232-1421
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
95007344
CA
Other
Enumeration date
10/05/2017
Last updated
10/05/2017
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