Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | 751589 | TX |
NPI | 1003153131 |
---|---|
Provider Name | Christina Hagood |
First Address | Dallas, TX 75214-3922 |
Second Address | Dallas, TX 75214-3922 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/01/2013 |
Last Update Date | 18/07/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
P01174436 | MCRR (01) |