Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RR0500X | Rheumatology | 1026508 | TX |
N | 207RR0500X | Rheumatology | F11200688 | TX |
NPI | 1033870456 |
---|---|
Provider Name | Marie Charisse Impe |
First Address | Corpus Christi, TX 78415-1800 |
Second Address | Corpus Christi, TX 78415-1800 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/01/2022 |
Last Update Date | 07/01/2022 |