Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | 1035112 | TX |
NPI | 1386304350 |
---|---|
Provider Name | Andrea Carnevale |
First Address | Temple, TX 76508-0001 |
Second Address | Temple, TX 76508-0001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/12/2021 |
Last Update Date | 17/12/2021 |