Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | 1052508 | TX |
NPI | 1063183929 |
---|---|
Provider Name | Macey Naegelin |
First Address | Fort Worth, TX 76109-4931 |
Second Address | Fort Worth, TX 76109-4931 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/09/2021 |
Last Update Date | 21/09/2021 |