Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | BP10060606 | TX |
Y | 111NI0900X | Internist | BP10060606 | TX |
NPI | 1003349960 |
---|---|
Provider Name | Dr. Nisha Dhanabalsamy |
First Address | Grand Prairie, TX 75052-3017 |
Second Address | Fort Worth, TX 76104-3902 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/04/2017 |
Last Update Date | 04/08/2020 |