Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | AP136065 | TX |
NPI | 1003323015 |
---|---|
Provider Name | Mirabelle Nofeh |
First Address | El Paso, TX 79912-5919 |
Second Address | El Paso, TX 79928-7803 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/12/2017 |
Last Update Date | 21/08/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
AP136065 | AP LICENSE (01) | TX |