ANDREA BANOUVONG

SAN LORENZO, CA
NPI1073137634
Entity TypeIndividual
GenderFemale
Sole Proprietor ?Yes
Primary Taxonomy363L00000X Nurse Practitioner
(Licence: CA  95013507)
Additional Taxonomies363LA2100X Nurse Practitioner, Acute Care
(Licence: CA  95013507)
Enumeration Date2020-05-29
Last Update Date2020-05-29
Business Address
ANDREA BANOUVONG
927 VIA HONDA
SAN LORENZO, CA 94580-2815
Phone number: 510-407-0749
Mailing Address
ANDREA BANOUVONG
927 VIA HONDA
SAN LORENZO, CA 94580-2815
Phone number: 510-407-0749
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