Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | 249719 | TX |
NPI | 1114988722 |
---|---|
Provider Name | Glenn Temple |
First Address | Corpus Christi, TX 78414-4124 |
Second Address | Corpus Christi, TX 78414-4124 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/03/2006 |
Last Update Date | 27/04/2021 |