Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | AP137179 | TX |
NPI | 1013407824 |
---|---|
Provider Name | Greta Jo Kissel |
First Address | Denton, TX 76201-2376 |
Second Address | Denton, TX 76201-2376 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/05/2018 |
Last Update Date | 01/06/2021 |