Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | AP130587 | TX |
NPI | 1164882874 |
---|---|
Provider Name | Mr. Jeremiah Stecki |
First Address | San Antonio, TX 78229-3539 |
Second Address | San Antonio, TX 78229-3539 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/02/2016 |
Last Update Date | 24/06/2016 |