Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 58225 | NM |
N | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | AP141620 | TX |
NPI | 1033752324 |
---|---|
Provider Name | Misper Etando |
First Address | Houston, TX 77082-2168 |
Second Address | Santa Fe, NM 87507-4851 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/10/2019 |
Last Update Date | 05/12/2019 |