Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | K1230 | TX |
N | 207Q00000X | Family Doctor | K1230 | TX |
NPI | 1104874809 |
---|---|
Provider Name | Janet Krueger |
First Address | Bryan, TX 77802-5361 |
Second Address | College Station, TX 77845-6176 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2006 |
Last Update Date | 29/11/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
113489209 | (05) | TX |
H00252 | (02) | TX |