Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251C2600X | Cardiopulmonary | 1278467 | TX |
NPI | 1992253397 |
---|---|
Provider Name | Amy Mellang |
First Address | Shenandoah, TX 77385-8706 |
Second Address | Shenandoah, TX 77385-8706 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/09/2016 |
Last Update Date | 14/09/2016 |