Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | 99303 | TX |
NPI | 1033635776 |
---|---|
Provider Name | Amber Berry |
First Address | Humble, TX 77346-1889 |
Second Address | Humble, TX 77346-1889 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/08/2017 |
Last Update Date | 15/08/2017 |