Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | 585550 | TX |
NPI | 1083770945 |
---|---|
Provider Name | Marilyn J. Hannafious |
First Address | Dallas, TX 75266-0599 |
Second Address | Dallas, TX 75217-4151 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/12/2006 |
Last Update Date | 13/04/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
140078016 | (05) | TX |
140078019 | (05) | TX |
140078020 | (05) | TX |
140078021 | (05) | TX |
140078022 | (05) | TX |
140078023 | (05) | TX |
140078024 | (05) | TX |
140078025 | (05) | TX |
140078026 | (05) | TX |
140078027 | (05) | TX |
140078028 | (05) | TX |
8Y2909 | BLUE CROSS BLUE SHIELD (01) | TX |