Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207PP0204X | Pediatric Emergency Physician | 1000151 | TX |
Y | 363L00000X | Nurse Practitioner | 1000151 | TX |
NPI | 1275108755 |
---|---|
Provider Name | Brandon Visneau |
First Address | Fulshear, TX 77441-2205 |
Second Address | Houston, TX 77094-1285 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/05/2021 |
Last Update Date | 12/10/2021 |