Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LW0102X | Nurse Practitioner - Women's Health | 516186 | TX |
NPI | 1033123781 |
---|---|
Provider Name | Karen Brock |
First Address | Conroe, TX 77304-2845 |
Second Address | Conroe, TX 77304-2845 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2006 |
Last Update Date | 27/01/2022 |