Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | 537125 | TX |
NPI | 1205866126 |
---|---|
Provider Name | Mrs. Christina Mechelle Larrison |
First Address | Fort Worth, TX 76104-2122 |
Second Address | Fort Worth, TX 76104 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/07/2006 |
Last Update Date | 08/07/2007 |