Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | 9871 | TX |
NPI | 1659561058 |
---|---|
Provider Name | Dr. Amy Dionne Harris |
First Address | Rockwall, TX 75032-6670 |
Second Address | Quinlan, TX 75474-8989 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/07/2007 |
Last Update Date | 31/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
V02266 | (02) | TX |