Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207QA0505X | Family Doctor - Adult Medicine | 1057185 | TX |
Y | 363L00000X | Nurse Practitioner | 1057185 | TX |
NPI | 1043974181 |
---|---|
Provider Name | Avneet Kaur Bajwa |
First Address | Frisco, TX 75033-0574 |
Second Address | Frisco, TX 75035-4654 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/10/2021 |
Last Update Date | 17/11/2021 |