Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | 693115 | TX |
NPI | 1043458276 |
---|---|
Provider Name | Megan Mineur Cousin |
First Address | White Settlement, TX 76108-2929 |
Second Address | Fort Worth, TX 76104-2122 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/01/2009 |
Last Update Date | 02/02/2009 |