Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | 595197 | TX |
NPI | 1033273388 |
---|---|
Provider Name | Leslee M. Roberts |
First Address | Dallas, TX 75266-0599 |
Second Address | Dallas, TX 75235-7708 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/12/2006 |
Last Update Date | 18/12/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
191975501 | (05) | TX |
191975502 | (05) | TX |
8Y4072 | BLUE CROSS BLUE SHIELD (01) | TX |