Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | 524624 | TX |
NPI | 1083778906 |
---|---|
Provider Name | Lilah Jan Andrews |
First Address | Dallas, TX 75266-0599 |
Second Address | Dallas, TX 75211-1656 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/12/2006 |
Last Update Date | 25/09/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4754102 | TPI (01) | TX |