is a Pediatrics in , . practices all healthcare services and medical treatments related to Pediatrics. The NPI Number for is 1205888799. The last update date is .
's current location address is , , . You can contact this provider via phone number . The mailing address for is , , . To know further, please read the information below!
Provider Profile Detail
Provider Name | |
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Address | , , |
Phone Number | |
Fax Number | |
Sole Proprietor | -- |
Credentials | -- |
NPI Number Detail
NPI Number | 1205888799 |
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Provider Enumeration Date | |
Last Updated Date |
Provider Mailing Address Detail
Address | |
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City | |
State | () |
Post Code | |
Phone Number | |
Fax Number |
Provider's Primary Taxonomy Detail
Speciality | Pediatrics |
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Taxonomy | 363Lp0200X |
Licence No | 96644 |
Definition: An advanced practice registered nurse expert in providing care to infants, children and adolescents. |
Provider's Other Legacy Identifiers
Identifier | Identifier Type | Identifier State | Identifier Issuer |
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129982807 | TX | -- | |
677248 | TX | RN LICENSE # |
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