Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LA2100X | Nurse Practitioner - Acute Care | PA07194 | TX |
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | PA07194 | TX |
NPI | 1396040903 |
---|---|
Provider Name | Mr. Michael Dru Abrego |
First Address | Texas City, TX 77591-2546 |
Second Address | Texas City, TX 77591-2546 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/01/2011 |
Last Update Date | 24/04/2012 |