Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 87916 | OK |
N | 363LF0000X | Nurse Practitioner - Family Medicine | AP137668 | TX |
NPI | 1003317991 |
---|---|
Provider Name | Elizabeth Walrath |
First Address | Plano, TX 75093-8900 |
Second Address | Tulsa, OK 74135-2921 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/02/2018 |
Last Update Date | 12/11/2021 |