Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | AP143657 | TX |
NPI | 1609487099 |
---|---|
Provider Name | Katherine Otecca Wills |
First Address | Austin, TX 78702-4067 |
Second Address | Austin, TX 78756-4080 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/08/2020 |
Last Update Date | 11/08/2020 |