Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | AP145826 | TX |
NPI | 1255963468 |
---|---|
Provider Name | Melanie Marie Vague |
First Address | Cedar Park, TX 78613-6961 |
Second Address | Austin, TX 78758-2401 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/02/2020 |
Last Update Date | 14/04/2020 |