Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | 230128 | TX |
NPI | 1023174984 |
---|---|
Provider Name | Elsie L. Hider |
First Address | Dallas, TX 75266-0599 |
Second Address | Dallas, TX 75224-4968 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/12/2006 |
Last Update Date | 27/08/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
041520002 | (05) | TX |
041520003 | (05) | TX |
S82336 | (02) |