Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PP0204X | Pediatric Emergency Physician | L3037 | TX |
N | 2080P0204X | Pediatric Emergency Doctor | 48149 | WI |
NPI | 1275585945 |
---|---|
Provider Name | Dr. Jo-Ann O Nesiama |
First Address | Dallas, TX 75235-7701 |
Second Address | Dallas, TX 75235-7701 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/05/2006 |
Last Update Date | 03/10/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
039906262Y | HUMANA (01) | |
34662400 | (05) | WI |
I40174 | (02) |