Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC1500X | Nurse Practitioner - Community Health | AP128282 | TX |
NPI | 1720460215 |
---|---|
Provider Name | Julia Lynn Anderson |
First Address | College Station, TX 77845-5981 |
Second Address | Bryan, TX 77803-5317 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2015 |
Last Update Date | 22/06/2015 |