Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0200X | Critical Care Medicine | R2182 | TX |
Y | 207RP1001X | Pulmonary Disease | R2182 | TX |
NPI | 1003198391 |
---|---|
Provider Name | Dr. Varalaxmi Bhavani Nannaka |
First Address | Tyler, TX 75701-2018 |
Second Address | Tyler, TX 75701-2018 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/09/2011 |
Last Update Date | 21/11/2019 |