Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | 253573 | TX |
NPI | 1003985342 |
---|---|
Provider Name | Kathleen Marie Mcinnis |
First Address | San Antonio, TX 78229-3561 |
Second Address | San Antonio, TX 78229-3561 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/11/2006 |
Last Update Date | 21/01/2021 |