Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | AP125598 | TX |
NPI | 1245600154 |
---|---|
Provider Name | Jennifer Sorrelle-Ferguson |
First Address | Houston, TX 77024 |
Second Address | Houston, TX 77024 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/10/2015 |
Last Update Date | 24/08/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1245600154 | (05) | AZ |