Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | 760589 | TX |
NPI | 1104162304 |
---|---|
Provider Name | Karina Wyckstandt |
First Address | Houston, TX 77046-0297 |
Second Address | Houston, TX 77030-2608 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/12/2012 |
Last Update Date | 17/12/2012 |