Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | 607323 | TX |
NPI | 1083614242 |
---|---|
Provider Name | Cheryl D. Pittman |
First Address | Dallas, TX 75266-0599 |
Second Address | Dallas, TX 75235-7708 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2005 |
Last Update Date | 22/11/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
145528903 | (05) | TX |
145528904 | (05) | TX |
8Y0753 | BLUE CROSS BLUE SHIELD (01) | TX |
Q78414 | (02) |