Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | 99421 | TX |
NPI | 1104439926 |
---|---|
Provider Name | Leena Pacak |
First Address | Austin, TX 78723-5711 |
Second Address | Austin, TX 78704-4238 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2020 |
Last Update Date | 31/08/2020 |