Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | 99338 | TX |
NPI | 1144715814 |
---|---|
Provider Name | Jennifer Marie Chrisman |
First Address | Commerce, TX 75428-5243 |
Second Address | Commerce, TX 75428-5243 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/06/2018 |
Last Update Date | 26/06/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
20901746 | DRIVERS LICENSE (01) | TX |