Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | F04170205 | TX |
NPI | 1003326687 |
---|---|
Provider Name | Elizabeth Nabila Khan |
First Address | Austin, TX 78753-2101 |
Second Address | Austin, TX 78753-2101 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/10/2017 |
Last Update Date | 09/10/2017 |