Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 0001189323 | TX |
NPI | 1003181371 |
---|---|
Provider Name | Frehiwot Bezuayehu |
First Address | Plano, TX 75074 |
Second Address | Plano, TX 75023 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/03/2012 |
Last Update Date | 06/09/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0001189323 | APN LICENSE (01) | TX |