Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | 741134 | TX |
NPI | 1033558515 |
---|---|
Provider Name | Craystal Gail Salazar |
First Address | Greenville, TX 75401-5644 |
Second Address | Greenville, TX 75401-5639 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/06/2013 |
Last Update Date | 12/08/2015 |