Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175F00000X | Naturopath | 21-00068 | KS |
NPI | 1003493156 |
---|---|
Provider Name | Dr. Nicole Shusterman |
First Address | Frisco, TX 75035-0958 |
Second Address | Dallas, TX 75252-5730 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/03/2021 |
Last Update Date | 06/04/2021 |