Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | 1048105 | TX |
NPI | 1023785045 |
---|---|
Provider Name | Jamie G Dodd |
First Address | Sherman, TX 75090-5189 |
Second Address | Denison, TX 75020 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/08/2021 |
Last Update Date | 26/08/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1048105 | TX BON LICENSE NUMBER (01) | TX |