Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | 32217 | TX |
NPI | 1053957472 |
---|---|
Provider Name | Avonne Danell Rosario |
First Address | Olathe, KS 66062-9010 |
Second Address | Kansas City, MO 64133-1593 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/11/2019 |
Last Update Date | 20/11/2019 |