Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 2021036599 | TX |
NPI | 1033797162 |
---|---|
Provider Name | Judith Irabor |
First Address | Spring, TX 77379-7577 |
Second Address | The Woodlands, TX 77381-4546 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/03/2021 |
Last Update Date | 08/11/2021 |