Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | AP110073 | TX |
NPI | 1003821166 |
---|---|
Provider Name | Ellen B Jatinen |
First Address | Austin, TX 78746-5059 |
Second Address | Austin, TX 78746-5059 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/07/2006 |
Last Update Date | 14/10/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
158616601 | (05) | TX |
158616603 | (05) | TX |
158616604 | (05) | TX |
158616606 | (05) | TX |