Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | AP1008907 | TX |
NPI | 1003573775 |
---|---|
Provider Name | Liji Ann Mathew |
First Address | Edinburg, TX 78539-4345 |
Second Address | Mcallen, TX 78504-6117 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/11/2021 |
Last Update Date | 17/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
23157422 | TEXAS DL NUMBER (01) | TX |