Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | 251906 | TX |
NPI | 1013097252 |
---|---|
Provider Name | Mary B. Markovich |
First Address | Houston, TX 77210-4439 |
Second Address | Houston, TX 77030-4009 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/10/2006 |
Last Update Date | 20/08/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
42586002 | (05) | TX |
8N4905 | BCBS (01) | TX |
P00169820 | RR MEDICARE (01) | TX |
S76535 | (02) |