Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 1029002 | TX |
N | 363LA2200X | Nurse Practitioner - Adult Health | 1029002 | TX |
N | 363LG0600X | Nurse Practitioner - Gerontology | 1029002 | TX |
N | 363LP2300X | Nurse Practitioner - Primary Care | 1029002 | TX |
NPI | 1083280226 |
---|---|
Provider Name | Lauren G Ty |
First Address | Tomball, TX 77377 |
Second Address | Tomball, TX 77377 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/05/2021 |
Last Update Date | 28/05/2021 |