Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | AP134088 | TX |
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | AP134088 | TX |
NPI | 1518492701 |
---|---|
Provider Name | Marius Fegaing |
First Address | Dallas, TX 75203-1201 |
Second Address | Dallas, TX 75208-2312 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/04/2017 |
Last Update Date | 28/08/2019 |