Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0000X | Internist - Cardiovascular Disease | 72258 | WI |
Y | 207RC0000X | Internist - Cardiovascular Disease | L6646 | TX |
N | 207RI0011X | Interventional Cardiology | L6646 | TX |
NPI | 1114074135 |
---|---|
Provider Name | Jennifer A Naiser |
First Address | Granbury, TX 76048-5689 |
Second Address | Granbury, TX 76048-5689 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/01/2007 |
Last Update Date | 08/12/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01253772 | AMERIGROUP (01) | TX |
8CC832 | BCBS (01) | TX |
8L-8489 | (02) | TX |