Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LG0600X | Nurse Practitioner - Gerontology | 589779 | TX |
NPI | 1023002722 |
---|---|
Provider Name | Milbrey Raney |
First Address | Austin, TX 78745-5259 |
Second Address | Austin, TX 78745-5259 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/09/2005 |
Last Update Date | 08/07/2007 |