Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | 1049284 | TX |
NPI | 1063186724 |
---|---|
Provider Name | Mary N Kangethe |
First Address | Pearland, TX 77584-6106 |
Second Address | Pearland, TX 77584-6106 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/08/2021 |
Last Update Date | 05/08/2021 |