Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | AP145574 | TX |
NPI | 1154957744 |
---|---|
Provider Name | Erica Vickers |
First Address | Navasota, TX 77868-3761 |
Second Address | Houston, TX 77030-1501 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/03/2020 |
Last Update Date | 16/03/2020 |