Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | AP140903 | TX |
NPI | 1013550573 |
---|---|
Provider Name | Eliana Victoria Jimenez |
First Address | Webster, TX 77598-4220 |
Second Address | Webster, TX 77598-4220 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/10/2019 |
Last Update Date | 27/01/2022 |