Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | 744909 | TX |
NPI | 1043409204 |
---|---|
Provider Name | Meenakshi Shaili |
First Address | Dallas, TX 75266-0599 |
Second Address | Dallas, TX 75211-1656 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/10/2007 |
Last Update Date | 16/06/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
196033801 | (05) | TX |
196033802 | (05) | TX |
196033804 | (05) | TX |
196033805 | (05) | TX |
196033806 | (05) | TX |
196033807 | (05) | TX |
196033808 | (05) | TX |
196033809 | (05) | TX |
196033810 | (05) | TX |
88326U | BLUE CROSS BLUE SHIELD (01) | TX |