Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | AP145824 | TX |
NPI | 1033716022 |
---|---|
Provider Name | Michael Pacifico Conde |
First Address | Humble, TX 77338-1478 |
Second Address | Kingwood, TX 77339-4412 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2020 |
Last Update Date | 03/10/2020 |