Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | AP134669 | TX |
N | 363LA2100X | Nurse Practitioner - Acute Care | AP134669 | TX |
NPI | 1013433572 |
---|---|
Provider Name | Mr. Ronald Everett Stafford |
First Address | Sugar Land, TX 77479-1420 |
Second Address | Houston, TX 77089-6097 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/08/2017 |
Last Update Date | 28/07/2020 |