Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | 1031611 | TX |
NPI | 1033796354 |
---|---|
Provider Name | Ashley Tate Mouri |
First Address | Allen, TX 75013-6536 |
Second Address | Lewisville, TX 75057-3641 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/03/2021 |
Last Update Date | 24/03/2021 |