Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | 10942 | TX |
NPI | 1508012949 |
---|---|
Provider Name | Dr. Christina Carol O'brien |
First Address | Highland Village, TX 75077-7188 |
Second Address | Highland Village, TX 75077-7188 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/08/2008 |
Last Update Date | 18/08/2008 |