Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | AP123544 | TX |
NPI | 1023456134 |
---|---|
Provider Name | Lebaone Llulu Mogotsakgotla |
First Address | Houston, TX 77077-6220 |
Second Address | Houston, TX 77077-6220 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/06/2013 |
Last Update Date | 28/09/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
327062101 | (05) | TX |