Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | AP130775 | TX |
NPI | 1003261512 |
---|---|
Provider Name | Daryl Keith Motsenbocker |
First Address | Denton, TX 76209-4624 |
Second Address | Dallas, TX 75208-2363 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/05/2016 |
Last Update Date | 03/05/2016 |