Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 756904 | TX |
NPI | 1003168055 |
---|---|
Provider Name | Maegin M Carlile |
First Address | San Angelo, TX 76902-7200 |
Second Address | San Angelo, TX 76903-5919 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/10/2012 |
Last Update Date | 15/10/2012 |