Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | 708816 | TX |
NPI | 1205072840 |
---|---|
Provider Name | Michelle Elaine Beeson |
First Address | Sunrise, FL 33323-2843 |
Second Address | Dallas, TX 75246-2017 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/01/2009 |
Last Update Date | 04/01/2009 |