Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | AP123374 | TX |
NPI | 1013272772 |
---|---|
Provider Name | Julia Kviatkovskaya |
First Address | Fabens, TX 79838 |
Second Address | Fabens, TX 79838 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/07/2012 |
Last Update Date | 26/02/2016 |