Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | 1051975 | TX |
NPI | 1104594258 |
---|---|
Provider Name | Lucia Fernandez |
First Address | El Paso, TX 79938-4812 |
Second Address | El Paso, TX 79905-2705 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/09/2021 |
Last Update Date | 08/09/2021 |