Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | NP130900 | TX |
NPI | 1083060024 |
---|---|
Provider Name | Cristina Roberts |
First Address | Waller, TX 77484-9633 |
Second Address | Waller, TX 77484-9633 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/05/2016 |
Last Update Date | 09/05/2016 |