Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | 710434 | TX |
NPI | 1184864316 |
---|---|
Provider Name | Ellen Owens |
First Address | Shenandoah, TX 77380-3218 |
Second Address | Shenandoah, TX 77380-3218 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/02/2009 |
Last Update Date | 01/03/2009 |