Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | AP129907 | TX |
NPI | 1023539855 |
---|---|
Provider Name | Janice Soileau |
First Address | Georgetown, TX 78626-7703 |
Second Address | Georgetown, TX 78626-7703 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/07/2017 |
Last Update Date | 17/03/2018 |