Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | F11210147 | TX |
N | 363LP2300X | Nurse Practitioner - Primary Care | F11210147 | TX |
NPI | 1073266862 |
---|---|
Provider Name | Mildred Okumu |
First Address | Fate, TX 75189-4906 |
Second Address | Fate, TX 75189-4906 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/02/2022 |
Last Update Date | 01/02/2022 |