Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | 505872 | TX |
NPI | 1093066409 |
---|---|
Provider Name | Belsy Jose Koruthu |
First Address | Mckinney, TX 75069-2141 |
Second Address | Mckinney, TX 75069-2141 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/09/2012 |
Last Update Date | 25/09/2012 |