Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RH0003X | Hematology & Oncology | 1032839 | TX |
Y | 363L00000X | Nurse Practitioner | 1032839 | TX |
NPI | 1003497819 |
---|---|
Provider Name | Lindsey Pittillo |
First Address | Dallas, TX 75391-1230 |
Second Address | Abilene, TX 79606-5208 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/04/2021 |
Last Update Date | 03/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
423108601 | (05) | TX |