Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LP2300X | Nurse Practitioner - Primary Care | 1025793 | TX |
NPI | 1043873516 |
---|---|
Provider Name | Girmachew Haile |
First Address | Melissa, TX 75454-1801 |
Second Address | Melissa, TX 75454-1801 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/04/2019 |
Last Update Date | 04/06/2021 |