Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | AP139348 | TX |
NPI | 1003389008 |
---|---|
Provider Name | Mandy Landin |
First Address | San Antonio, TX 78245-3007 |
Second Address | San Antonio, TX 78224-1308 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/01/2019 |
Last Update Date | 02/01/2019 |