Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | 563631 | TX |
NPI | 1194927681 |
---|---|
Provider Name | Letricia Lynn Moss |
First Address | Spring Branch, TX 78070-5303 |
Second Address | San Antonio, TX 78224-1308 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/06/2007 |
Last Update Date | 06/01/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
563631 | NURSING LICENSE (01) | TX |