Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | 1031921 | TN |
NPI | 1497330542 |
---|---|
Provider Name | Caitlin Marie Konwisarz |
First Address | Katy, TX 77493-4017 |
Second Address | Houston, TX 77008-1532 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/03/2021 |
Last Update Date | 10/03/2021 |