Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | M0519 | TX |
NPI | 1053303511 |
---|---|
Provider Name | Dr. Amanda Parker Nylund |
First Address | Sugar Land, TX 77478-4941 |
Second Address | Sugar Land, TX 77479-2562 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/08/2005 |
Last Update Date | 26/11/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
173740501 | (05) | TX |
173740504 | (05) | TX |
173740505 | (05) | TX |
8R8311 | BCBS (01) | TX |
I30381 | (02) | TX |