Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | AP131879 | TX |
NPI | 1023567401 |
---|---|
Provider Name | Margaret O Egbonim |
First Address | Round Rock, TX 78665-1245 |
Second Address | Round Rock, TX 78665-1245 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/09/2016 |
Last Update Date | 27/09/2016 |