Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Y00000X | Otolaryngologist (ENT Doctor) | MD60209581 | WA |
NPI | 1033195417 |
---|---|
Provider Name | Dr. Nici Eddy Bothwell |
First Address | San Antonio, TX 78230-5470 |
Second Address | San Antonio, TX 78230-5470 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/12/2005 |
Last Update Date | 05/08/2020 |