Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 1030813 | TX |
NPI | 1023602307 |
---|---|
Provider Name | Aminata Wane |
First Address | Kingwood, TX 77339-6027 |
Second Address | Kingwood, TX 77339-6027 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/02/2021 |
Last Update Date | 27/02/2021 |