Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | AP142062 | TX |
N | 2080P0214X | Pediatric Pulmonologist | AP142062 | TX |
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 810497 | TX |
NPI | 1508416629 |
---|---|
Provider Name | Christa Standefer |
First Address | Dallas, TX 75373-3784 |
Second Address | Fort Worth, TX 76104-2710 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/09/2019 |
Last Update Date | 09/04/2021 |