Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | 6135 | TX |
NPI | 1093966590 |
---|---|
Provider Name | Dr. Roxanne Edrington |
First Address | Webster, TX 77598-4147 |
Second Address | Webster, TX 77598-4147 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/10/2008 |
Last Update Date | 02/10/2008 |