Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 4704250945 | MI |
NPI | 1003249913 |
---|---|
Provider Name | Hetal Rathod |
First Address | Austin, TX 78757-1098 |
Second Address | Cedar Park, TX 78613-7763 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/08/2013 |
Last Update Date | 08/12/2016 |