Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | AP191051 | TX |
NPI | 1023578051 |
---|---|
Provider Name | Melissa Michelle Andersen |
First Address | Sherman, TX 75090-5175 |
Second Address | Denton, TX 76201-5119 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/03/2019 |
Last Update Date | 22/05/2019 |