Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 6149 | AK |
N | 111NI0900X | Internist | 6149 | AK |
Y | 207RG0100X | Gastroenterologist | R5247 | TX |
N | 208000000X | Pediatrician | MD4336 | AK |
NPI | 1023153103 |
---|---|
Provider Name | Heather Lea Branstetter |
First Address | Ft Worth, TX 76132-4258 |
Second Address | Ft Worth, TX 76132-4258 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/02/2007 |
Last Update Date | 23/10/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1014965 | (05) | AK |