Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LN0000X | Nurse Practitioner - Neonatal | 725062 | TX |
Y | 363LN0000X | Nurse Practitioner - Neonatal | AP114732 | TX |
N | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | AP114732 | TX |
NPI | 1366483240 |
---|---|
Provider Name | Donna J Caruso |
First Address | Longview, TX 75601-5580 |
Second Address | Longview, TX 75601-5580 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2006 |
Last Update Date | 01/12/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
725062 | LICENSE NUMBER (01) | TX |