Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | AP137022 | TX |
NPI | 1003316142 |
---|---|
Provider Name | Lisa Ernest |
First Address | Irving, TX 75039-2014 |
Second Address | Dallas, TX 75233-1430 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/02/2018 |
Last Update Date | 12/04/2018 |