Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | AP145838 | TX |
NPI | 1457969917 |
---|---|
Provider Name | Grace Gathoni Kamau |
First Address | Dallas, TX 75203-1201 |
Second Address | Grand Prairie, TX 75054-7505 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/07/2020 |
Last Update Date | 21/07/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
AP145838 | AP145838 (01) | TX |