Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LG0600X | Nurse Practitioner - Gerontology | 1032099 | TX |
NPI | 1043826373 |
---|---|
Provider Name | Christine Samuel |
First Address | Houston, TX 77210-4439 |
Second Address | Houston, TX 77030-4000 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/09/2020 |
Last Update Date | 22/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
429142901 | (05) | TX |
429142902 | CSHCN MEDICAID TPI (01) | |
8QE473 | BLUE CROSS BLUE SHEILD (01) |